Ethical Considerations: Dignity, Respect and Communication in Nursing

This essay delves into the ethical complexities of nursing, using a case study of Mrs. Wang, a patient with lung cancer whose family requests non-disclosure of her diagnosis. The essay examines core ethical principles such as autonomy, beneficence, non-maleficence, and justice, highlighting their significance in safeguarding patient rights and promoting dignity and respect. It discusses relevant legislation like The Care Act 2014 and the Mental Capacity Act, emphasizing the importance of informed consent and patient autonomy. The essay also explores the role of healthcare professionals in maintaining effective communication, utilizing interpersonal skills to foster a positive patient experience, and addressing language barriers to ensure comprehensive care. It stresses the importance of the 7 Cs of communication (clear, concise, concrete, correct, coherent, complete, and courteous) and the development of interpersonal skills such as active listening, empathy, and teamwork to improve patient outcomes and uphold ethical standards in nursing practice.

Running Head: DIGNITY AND RESPECT
FOSTERING DIGNITY AND RESPECT
Name of the Student
Name of the University
Author’s Note

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Question 1
The ethical concepts in the profession of nursing is considered to safeguard the rights of
the patient and deliver quality care with the use of power. In this case study, Mrs. Wang is
suffering from lung cancer with a poor prognosis and she is going to survive for a limited time
according to her condition. Her first language is Mandarin and she is comfortable in
communicating in Mandarin more than English. She has two sons who has accompanied her to
the health appointments and they have been interpreting her in Mandarin. However, Mrs. Wang’s
son and her extended family has requested the medical team to not reveal about her diagnosis or
her current medical condition and tell her that her tumour is non-malignant. This incident shows
that the ethical principles should be used to safeguard Mrs. Wang’s freedom, responsibilities,
rights and the use of power in care. The government of United Kingdom has several policies and
legislations to safeguard adults such as The Care Act 2014, The Mental Capacity Act, and
Deprivation of Liberty Safeguards (Betts, Marks-Maran and Morris-Thompson 2014). Core
ethical principles are utilized in a healthcare setting and it provides a foundation for complex
decision making by recognizing certain factors and effects of the care process. Depriving Mrs
Wang about her health information also obstructs her right to life, which violates human right act
article 2 because it declares that no one has the right to end anyone’s life including the
government and they should make necessary plans and policies to safeguard the right of an
individual. Public authorities such as health care organizations should give importance to the
right to life while making any decisions that can influence the life of a patient or can reduce the
life expectancy (Equalityhumanrights.com 2019). Valuing people is another aspect in the
healthcare industry as expressed by the Department of Health (UK). It focuses on the general
requirements of an individual such as dignity, respect, fairness, the ability to judge, interacting

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with people through effective communication, non-stereotyping people according to their
religion or culture, not giving people labels, and promoting beneficence.
As Chagani (2014), says the four key principles are non-maleficence, beneficence,
autonomy and justice. All these principle focuses on the freedom and rights of the patient, which
is related to the power in care. Mrs Wang’s respect and dignity should be fostered so that she is
not deprived of her rights and fundamental choices. Her son’s decision to keep her unaware
about her medical condition is the violation of her autonomy and justice. The nurses are going to
experience the issue of ethical dilemma in this case because a patient should be aware about their
medical procedure so that they can give their opinions and consent, but her sons have requested
the medical experts to not inform anything to her mother, which is not considered ethical (Chong
et al. 2015). This makes it necessary for implementing the ethical concepts that ensures freedom,
rights, responsibilities and the use of power in care including the application of different
strategies by her medical team to support and respect her dignity. Every patient deserves respect
and dignity from their healthcare organization, which can only be promised when the people are
aware about their roles, responsibilities and the maturity to act according to the situation. This
includes the role of a nurse such as the duty of care and duty of candour, which expects the nurse
to be open and vocal with her patients. When something is wrong with the patient, be it their
diagnosis or treatment then the nurse should share the information with their patient and take
measures to make it right. They should be supportive of the patient’s dilemma and make them
feel positive about their procedures, which should also happen in Mrs Wang’s situation
(Nmc.org.uk 2019).
The ethical concepts to be considered in her case is non maleficence, beneficence,
autonomy and justice. Firstly, non-maleficence means doing no harm. A patient should not be

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harmed through any means and under any circumstances and if it is done then it should be
validated according to the professional and ethical judgment and guidance. This makes both
physical and psychological harm invalid, which is only considered when evidence based practice
is given the utmost importance. Appropriate measures and interventions should be implemented
by the nurses for the wellbeing and safety of the patient in a medical setting. Maximum effort
should be given to minimize the risk involved in a patient’s treatment. This principle might not
be directly related to Mrs. Wang but it can be considered during her treatment because she will
not be informed about her condition and prognosis, which is against the ethical principles. The
second ethical principle is Beneficence, which states that people in the healthcare sectors should
do everything that provides benefit to the patient in certain situations. The treatment and
procedures done for any patient should be of optimum value and should give them maximum
benefits in terms of health and quality (Epstein et al. 2017). Beneficence can be maintained when
the healthcare professionals decide to enhance their skills and knowledge to deliver quality care
to patients and that can be obtained through advanced training and experience with latest medical
practices. The mental capability of providing certain patients with a particular treatment
according their condition should be given importance so that other patients do not get the same
treatment if it is not suitable for them. This ethical principle aims towards the optimum
satisfaction of a patient in a healthcare. The third principle is Autonomy, which is the most vital
principle in Mrs Wang’s case due to its characteristics. Autonomy in the medical sector is
understood as the right of the patient over their body, which they can control. The role of the
healthcare expert is to guide and supervise the patient regarding their treatment and medical
complication but it is the final of the patient to consider the options and come to a decision
through the process of effective decision making. Anyone trying to influence or change the

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decision of the patient is violating the principle of autonomy. The patient has all the rights to
make decisions about their wellbeing and the medical practitioner should follow them even if
they feel it is not beneficial for the patient. The opinion and decision of the patient is ultimate
and should be depending upon their personal beliefs and values. The fourth and the last principle
is justice that implies that all decisions made in the medical field should be fair for all
irrespective of any criteria. The equal distribution of resources and facilities should be necessary
for applying justice in the practical field, which will ensure benefits and burdens under fairness.
The implementation of justified laws and legislations should be taken into action when such
situations occur that violates the rights and duties of a patient. It should be considered while
making any choices (Salminen et al. 2016).
The people involved in her support should consider options that will not harm the dignity
and respect of Mrs Wang. This can be only implemented when they follow the ethical principles
while considering the cultural difference of Mrs Wang because she is a Chinese and that can
influence her thought process. The initial strategy would be to prioritize her health and that
requires several medical interventions such as holistic approach of care and herbal treatment to
control her health complication of lung cancer. The nurses should look after her dignity and
respect, and should give her information that are related to her health without following the order
of her sons who are violating her right to life and autonomy.
Question 2
The professionals responsible in Mrs Wang’s case need to maintain effective
communication and utilize their interpersonal skills that includes compassion, dignity and respect
that can deliver positive patient outcome. She is in a critical stage that requires attention and
optimum care from the healthcare professionals, which is only possible through efficient

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performance and therapeutic communication. A healthy communication is the healthy exchange
of information from both the mediums, which is required in Mrs Wang’s case as her loved ones
requested her health team to not disclose her health complications specifically about retaining the
information about her tumour. According to Bramhall (2014), communication has 7 Cs that
needs to be followed for effective communication with others and they include clear, concise,
concrete, correct, coherent, complete and courteous. The first C is clear, which requires a person
to state or write clearly about their messages or goals and the person needs to be clear about who
they want to communicate with and why. If this is not clear then effective communication cannot
take place. The second C is concise, which requires a person to be brief and crisp about the point
they are trying to make. Irrespective of the type of communication a person should be always to
the point and should not distract others with irrelevant information such as the use of excess
words when only few is required for the purpose. The third C is concrete, which means that the
message should be solid with utmost clarity and it should not have many details. The message
should be to the point consisting of vivid facts and a sharp focus to the subject of the matter. The
fourth C is correct, which ensures that the communication should be correct without any false
information because a correct communication will not have any errors that is essential for
effective communication. The fifth C is coherent, which implies that communication should be
in sync to reality, which will ensure logical communication. This is possible when the
information given has relevant points connected to each other. The sixth C is complete, which
signifies that the listener in a conversation should be given the full information without leaving
any data that could be significant for an effective communication. It should consist of all relevant
information. The seventh and the last C is courteous, and it suggests that an effective
communication should be honest, friendly and honest without any derogatory or negative

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implications that includes insults, sarcasm and passive aggressive manner of talking. The
feelings and viewpoint of the other person should be taken into consideration while giving any
information or having a conversation. This model of communication ensures an efficient
communication between two medium and it can utilized in a medical setting especially for Mrs
Wang depending on the case study (Edexec.co.uk 2019). This will also enhance interpersonal
skills in medical practitioners, which will help them in respecting the rights of a patient by
protecting their dignity and respect. If the communication is not effective then it can lead to
severe consequences such as low satisfaction of patients, negative outcomes, inappropriate
treatment and also the violation of basic rights and ethical principles necessary in a healthcare
organization. It is necessary for healthcare professionals to enhance their interpersonal skills so
that they can improve their performance and attain maximum patient satisfaction, which only
help them in their future practice (Blanco et al. 2015). In the same way, measures should be
taken by nurses to deliver best care outcomes for Mrs Wang such as interacting with her
according to her preferred language and if they are unable to do so then they can take help from
people who know Mandarin. This will improve the first line of communication, which is
language barrier and it is an essential component in therapeutic communication. This will also
ensure the development of interpersonal skills that is required in a medical setting and it includes
active listening, communication skills, compassion, stress management, teamwork, problem
solving, and an attitude that includes self-confidence, empathy, and the ability to maintain
positive demeanour during any situation (Diffenderfer 2017). All these qualities will ensure
optimum care for Mrs Wang because she has a poor prognosis with deteriorating symptoms such
as breathless, loss of weight and persistent cough. These signs require critical intervention
because she is at the end stage of lung cancer because her tumour is malignant. She requires

7DIGNITY AND RESPECT
accurate cancer treatment that will improve her condition to an extent because she is at the end
stage, which is a critical state (Alvarez et al. 2015). The most necessary action required for Mrs
Wang is informing her about her tumour, which is malignant because hiding this critical
information about her is the violation of safeguarding policies and human rights act. Informing
her will give her the opportunity to make decisions about her treatment and further procedures
that will require her consent. To ensure best care outcomes she should be given high priority due
to her condition and intensity of her health complication as cancer is a life threatening disease
and she is already in the end stage with a poor prognosis that has less chances of recovery.
Effective communication that will help in telling Mrs Wang about her disease will safeguard her
compassion, dignity and respect that is the basic right of every patient. Policies and legislations
are designed to protect the right of such vulnerable patients, which makes it necessary for her
medical team to abide by the rules and inform her about the tumour. This will ensure best care
outcomes for Mrs Wang. She prefers Mandarin as a communication medium because it is her
first language, so the medical practitioners should respect her choice and communicate with her
depending on her first language. Nursing as a profession demands hospitality and care to the
utmost level, which can be achieved through effective communication, interpersonal skills, and
dignity and respect for the other individual. Mrs Wang’s situation requires therapeutic
communication and the non-violation of her rights as an adult and a patient (Hall and Mitchell
2016).
Question 3
This case study has contributed to my self-development, own learning and a helpful
practice in understanding dignity and respect, and it will be discussed through Gibb’s reflection
model. It is one of the popular models used in healthcare practice (Garneau 2016). The first step

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is description and to describe the case study, Mrs Wang is patient who is suffering from lung
with a poor prognosis and she has been admitted to St Thomas NHS Foundation Trust. She is
Chinese and Mandarin is her first language but due to cultural competence she is unable to speak
in her preferred language (van Rose et al. 2016). She is not completely able to understand
English so her sons translated her some information during health appointments. She has a
malignant tumor and she is in her end stage, however, her sons and her extended family has
requested the medical team to hide this information from her that includes giving Mrs Wang a
wrong information, which is that her tumors are non-malignant. The Feeling I was going through
was similar to an ethical dilemma because not revealing the truth to patients about their health is
violation of certain policies and legislations that are made to safeguard the rights of patients,
which includes this scenario. Necessary steps should be taken to ensure that Mrs Wang’s dignity
and respect is maintained and it is the responsibility of the medical team to work upon this
dilemma (Zahran et al. 2016). The evaluation done by me of this incident is that Mrs Wang
should not be deprived of her rights because she has the full right to make decisions about her
body and give informed consent regards to her treatment. Mrs Wang’s son’s interpretation of
Mandarin was the only positive part in the whole scenario because few things were understood
by her but hiding facts about her health condition is the negative aspect in the case study. The
analysis of this reflection suggests that things would have gone well if Mrs Wang was informed
about her condition through the translation of Mandarin because it made her feel comfortable
during a communication. Her poor prognosis is a matter of concern and it is the duties of the
nurse to ensure cancer treatment and end of life care (nhs.uk 2019). This experience made me
realize the importance of effective therapeutic communication and the severity of patient right
that includes following the laws and legislations to maintain quality care and safeguarding of

9DIGNITY AND RESPECT
adults. This experience will make me handle more complicated situations in future as it gave me
an exposure to the various difficulties faced and the importance of value in a healthcare setting,
which is defined by three principles known as meaningful therapeutic value to patient, changing
cost, quality and predictability according to the requirements of the medical provider, and the
payer has the offsetting risk (Baumhauer and Bozic, 2016). The action plan for this case study
will be ensuring end of life care including cancer treatment so that it increases her prognosis.
Palliative care is another term for her treatment as it focuses on managing pain and controlling
the distressing symptoms of the patient including social, psychological, and spiritual support for
the service user as well as their family members (Brinkman-Stoppelenburg, Rietjens and Van der
Heide 2014).

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References
Alvarez, J.G.B., González-Cao, M., Karachaliou, N., Santarpia, M., Viteri, S., Teixidó, C. and
Rosell, R., 2015. Advances in immunotherapy for treatment of lung cancer. Cancer biology &
medicine, 12(3), p.209.
Baumhauer, J.F. and Bozic, K.J., 2016. Value-based healthcare: patient-reported outcomes in
clinical decision making. Clinical Orthopaedics and Related Research®, 474(6), pp.1375-1378.
Betts, V., Marks-Maran, D. and Morris-Thompson, T., 2014. Safeguarding vulnerable
adults. Nursing Standard, 28(38).
Blanco, R., Maestu, I., de la Torre, M.G., Cassinello, A. and Nuñez, I., 2015. A review of the
management of elderly patients with non-small-cell lung cancer. Annals of Oncology, 26(3),
pp.451-463.
Bramhall, E., 2014. Effective communication skills in nursing practice. Nursing Standard
(2014+), 29(14), p.53.
Brinkman-Stoppelenburg, A., Rietjens, J.A. and Van der Heide, A., 2014. The effects of advance
care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), pp.1000-1025.
Chagani, S.M.I., 2014. Telling the truth-A tussle between four principles of ethics. Journal of
Clinical Research & Bioethics, 5(2), p.172.
Chong, J.A., Quah, Y.L., Yang, G.M., Menon, S. and Krishna, L.K.R., 2015. Patient and family
involvement in decision making for management of cancer patients at a centre in
Singapore. BMJ supportive & palliative care, 5(4), pp.420-426.

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Diffenderfer, T. 2017. The Top 7 Interpersonal Skills for NPs | Healthcare Careers. [online]
Clinician Today. Available at: https://cliniciantoday.com/the-top-7-interpersonal-skills-for-nps/
[Accessed 6 Feb. 2020].
Edexec.co.uk 2019. The seven Cs of Communication – Edexec.co.uk. [online] Edexec.co.uk.
Available at: https://edexec.co.uk/the-seven-cs-of-communication/ [Accessed 6 Feb. 2020].
Epstein, R.M., Duberstein, P.R., Fenton, J.J., Fiscella, K., Hoerger, M., Tancredi, D.J., Xing, G.,
Gramling, R., Mohile, S., Franks, P. and Kaesberg, P., 2017. Effect of a patient-centered
communication intervention on oncologist-patient communication, quality of life, and health care
utilization in advanced cancer: the VOICE randomized clinical trial. JAMA oncology, 3(1),
pp.92-100.
Equalityhumanrights.com 2019. Article 2: Right to life | Equality and Human Rights
Commission. [online] Equalityhumanrights.com. Available at:
https://www.equalityhumanrights.com/en/human-rights-act/article-2-right-life [Accessed 6 Feb.
2020].
Garneau, A.B., 2016. Critical reflection in cultural competence development: A framework for
undergraduate nursing education. Journal of Nursing Education, 55(3), pp.125-132.
Hall, J. and Mitchell, M., 2016. Dignity and respect in midwifery education in the UK: a survey
of Lead Midwives of Education. Nurse education in practice, 21, pp.9-15.
nhs.uk 2020. What end of life care involves. [online] nhs.uk. Available at:
https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-starts/ [Accessed 6
Feb. 2020].