Importance of lift teams to nurses

art & science ethical decision-making: 7

Ethics in nursing: the way forward Chaloner C (2007) Ethics in nursing: the way forward. Nursing Standard. 21, 38, 40-41. Date of acceptance: April 27 2007.

Summary This series of articles has been developed with the intention of increasing nurses' awareness of ethics and ethical decision-making and clarifying the relationship between ethical thinking and effective nursing practice. A number of issues have been examined fo show how efhics affects fhe professional role, buf many ofher clinical and non-clinical aspects of nursing demand ethical exploration. In the final article in the series, the relevance of ethics to effective nursing is emphasised and suggestions for enhancing fhe integration of ethical decision-making into practice are made.

Author Chris Chaloner is ethics adviser. Royal College of Nursing, London. Email: [email protected]

Keywords Ethics; Nursing: philosophy; Nursing: profession

These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standai-d.co.uk. For related articles visit our online archive and search using the keywords.

The relevance of ethics

Ethics is as relevant to the ordinary activities of life as to the extraordinary. Although this series has focused on topics such as euthanasia and abortion, it should be emphasised that ethics is not concerned solely with determining the rights and wrongs of such sensitive and contentious subjects. Despite their tendency to generate vociferous public debate, the critical exploration ofthe 'big issues' is a relatively minor feature of professional ethics. However, critical expositions ofthe ethical aspects of health care tend to focus on the more sensational issues and overlook the less exciting elements of professional practice. For example, the motivations of individual nurses, their beliefs and attitudes towards their work are significant factors in establishing the ethical characteristics of nursing. A critical consideration of how and why a nurse conducts him or herself in carrying out his or her role is as helpful to evaluating the ethical validity of professional practice as an investigation into, for example, the rights and wrongs of therapeutic human cloning or face transplants.

THE NATURE of the nurse-patient relationship, in which respect, confidence and privacy have important roles, demands that nurses consider the ethical nature of their actions. A fundamental feature of effective professional practice is the ability to reflect on the ethical issues nurses encounter on a daily basis. The articles in this series have provided an overview of ethics and ethical decision-making by exploring a number of topics in the context of ethical analysis. The belief that ethics, critical ethical thinking and decision- making are relevant to all aspects of professional - and personal - life has been emphasised.

As noted in the first article, some nurses may regard ethics as a remote concept that is of little practical value and associate it with theories and guidelines that have no immediate relevance to their role (Chaloner 2007). The series aimed to address these misconceptions and show how ethical analysis and decision-making contribute to everyday practice.

Other important ethical issues __ __

The inherent limitations of a short ethics series ha ve meant that only a few issues have been addressed. As has been emphasised throughout, critical ethical thinking can, and should, be applied to all aspects of the professional role and, consequently, the scope for ethical analysis is limitless. For example, issues such as genetics, mental health, care of older people and public health generate a broad range of specific ethical questions. Individually, each of these topics provides a basis for extensive ethical debate.

In addition to addressing everyday practice- based ethical decisions, nurses are increasingly being called on to contribute to wider ethical debates on issues affecting health care, nationally and globally. The ethical basis of strategic planning and health policy development must be informed by contributions from the nursing profession.

The future

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As this series has demonstrated, the impact of ethics and ethical decision-making on professional

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practice is being increasingly recognised. Raised ethical awareness and seemingly unceasing technological and social developments mean that the range and complexity of ethical issues that nurses and their colleagues should respond to will increase, emphasising the need for enhanced ethical sensitivity and reasoning skills. In recent years ethics has become an established element of professional education programmes and this will hopefully produce increasingly analytical and ethically inquisitive health professionals.

Final thoughts

To promote the successful integration of ethical decision-making into nursing, it is essential that ethics is perceived as an accessible and practical concept. A number of preconceptions and misconceptions persist about how and why ethics relates to professional practice. Applying ethics does not require a degree in philosophy or access to a lexicon of obscure terminology, but it does require thought and rationality. It is perhaps understandable, given the complexity of some of the ethics-related literature, that some individuals find ethics off-putting or irrelevant.

Ethics should be an ongoing feature of professional life rather than something that is only discussed when a problem arises. Ongoing ethical reflection can help to make ethics more relevant and interesting. One means of achieving this is for educationalists and managers to take advantage of individuals' shared understanding of ethics: most people hold a view on the rights and wrongs of certain topics - even if that view is 'I don't know' - and these views should be used to promote ethical discussion and to demonstrate the process of critical ethical analysis.

It is insufficient, in terms of applying ethics, to mechanically adhere to the 'rules' of good practice. Therefore, key ethical concepts such as autonomy, consent and confidentiality should be regularly examined to produce an informed appreciation of why the generally accepted ethical tenets of professional practice, for example, maintaining confidentiality, are 'right'.

Engaging in ethical deliberation can be challenging but it is also an enjoyable and rewarding experience. There are no 'right answers' in ethical debate, and exploring the issues in a considered and critically informed manner is a valuable and productive activity.

Conclusion ^ _ _

This series has examined some key ethical issues and established that ethics and critical ethical thinking are fundamental aspects of nursing. The primary objectives ofthe series have been to encourage nurses to apply ethics to their work

and to contribute to the de-mystification of a subject that many consider confusing, off-putting or irrelevant.

By examining the ethical features of some of the 'big issues', it has been possible to explore the nature of ethics and the ways in which ethics and professional practice may be aligned. The series has demonstrated that clinical competence demands effective ethical decision-making and that ethics is not a remote concept but is essential to good nursing practice.

A range of issues that relate directly to the day-to-day realities ofa nurse's clinical role, and indirectly via the processes of professional education, management and broader strategic developments, demand further critical ethical input from the nursing profession. It is hoped that this series has contributed to that undertaking NS

Reference Chaloner C (2007) An introduction to ethics in nursing. Nursing Standard. 21, 32, 42-46.

USEFUL RESOURCES Books: Ashcroft R, Lucassen A, Parker M, Verkerk M, Widdershoven G (2005) Case Analysis in Clinical Ethics. Cambridge University Peess, Cambridge.

Brazier M (2003) Medicine, Patients and the Law. Third edition. Penguin Books, London.

British Medical Association (2004) Medical Ethics Today: The BMA's Handbook of Ethics and Law. BMJ Books, London.

Garwood-Gowers A, Tingle J, Wheat K (Eds) (2005) Contemporary Issues in Healthcare Law and Ethics. Elsevier, London.

Glover J (1977) Causing Death and Saving Lives. Penguin Books, Harmondsworth.

Mason JK, Laurie GT (2005) Mason and McCall-Smith's Law and Medical Ethics. Seventh edition. Oxford University Press, Oxford.

Tingle J, Cribb A (Eds) (2002) Nursing Law and Ethics. Second edition. Blackwell Science, Oxford.

Websites:

Bioethics Today: www.bioethics-today.org

BioethicsWeb: www.intute.ac.ul</healthandlifesciences/bioethicsweb

International Philosophy of Nursing Society:

www.ipons.dundee.ac.uk/index.html

Nuffield Council on Bioethics: www.nuffieldbioethics.org

Royal College of General Practitioners Medical Ethics Portal: www.rcgp.org.uk/collegejnformation/collegejnformation/committees/

medicaLethics_committee.aspx

The Ethox Centre: www.ethox.org.uk

The International Centre for Nursing Ethics: www.nursing-ethics.org/

UK Clinical Ethics Network: www.ethics-network.org.uk/index.htm

Wellcome Trust Biomedical Ethics: www.wellcome.ac.uk/nodel016.html

World Medical Association Ethics Unit: www.wma.net/e/ethicsunit/index.htm

(Last accessed: May 8 2007)

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