Exploring the Theory and Application of Law and Ethical Reasoning in Nursing Practice
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Exploring the Theory and Application of Law and Ethical Reasoning in Nursing Practice
Nurses while going about their duties need to consider various factors that are likely to impact on their operations. This essay illustrates the need for nurses to comply with existing laws and ethical theories that determine how they should perform their activities. It identifies the laws that impact on nursing practice in the Singaporean context and explains how non-compliance to existing laws is in violation with how nurses ought to conduct their operations. It also identifies the various principles that determine nursing action while ensuring that every worker act in an acceptable manner that is not likely to generate controversies and dissatisfaction. The paper also mentions the effects of developing a code of conduct that often guide how individual practitioners conduct their activities. An effective code of conduct is one that provides direction on how to handle various issues in a manner that is acceptable and likely to give impressive results. In addition, the study presents recommendations that could improve how nurses abide by existing laws and ethical frameworks. The chief argument in this instance is that adherence to law, ethical principles, and code of conduct increases the chances for attaining satisfying results for both caregivers and patients.
Adherence to Law
The Singaporean government has introduced various laws that influence nursing practice that all practitioners need to follow. Hence, nurses should be familiar with all regulations to conduct their activities without much controversy or to avoid criticism from clients and other stakeholders. For example, nursing practitioners need to follow the provisions of the Nurses and Midwives Act of 1999 that was last revised in 2020. The regulation directs the registration and admission of nurses, as well as guides the cataloguing of midwives (Singapore Statutes Online, 2022). In addition, the legal provision directs the certification and registration of Advanced Practice Nurses. In addition, other laws in Singapore provides guidelines on the core skills and competencies of Registered Nurses and give regulations for independent midwifery/nursing practice. Thus, nursing practitioners should understand the laws that impact on their practice and take measures to comply with all provisions to avoid being a victim of non-compliance. Otherwise, being non-compliant could result in considerable effects that could deter how service providers conduct their operations. Non-adherence could also cause legal problems that usually cost the firm significantly.
Ethical Theories
Nurses in Singapore and other parts of the globe must understand that the profession is a manifestation of value depending on which it is morally upright to foster psychological and physical well-being. Such obligations entail making decisions. Ethical choices are judgements an individual makes on whether a particular action is correct or not. The chief goal of ethical reasoning is to acquire a clear perception on challenges to enhance acting in ethically responsible ways. Nurses according to Dimitrios et al. (2020) are morally responsible for the destructive effects of their activities when they freely and knowingly act in a particular way or caused an action to take place and knew that the action was morally inappropriate or would cause harm to others. Besides, nurses are morally responsible for the undesirable effects of their actions when they freely and knowingly failed to avert or act in response to a harmful practice, and they were aware it would be ethically incorrect for an individual to do this. Whereas there is no universally accepted description of what amounts to a morally incorrect act, it is commonly described and believed that they are acts that cause emotional or physical harm to others
More fundamentally, those involved in nursing practice in Singapore must engage in ethical reasoning while undergoing their activities. Dimitrios et al. (2020) write that ethics within healthcare are essential because employees must acknowledge healthcare constraints and dilemmas, make proper decisions depending on their values while observing the laws and regulations that govern them. Moreover, ethical judgement refers to the choices an individual makes on whether certain acts are right or incorrect. Dimitrios et al. (2020) argue that even though ethics does not adhere to ethical principles with specific responses, an awareness of ethical theory permits nurses to make decisions in a more comprehensive way and well thought out than is intuition or opinion. Furthermore, nurses are obliged to abide by ethical reasoning because this helps to differentiate and determine between decisions, right thinking, and actions and those that are incorrect, harmful, or hurtful to oneself and others. Typically, ethical reasons are dependent on conscientious reasoning of facts depending on moral standards and principles.
Nevertheless, scholars give the criteria that nurses could use in ethical reasoning that could improve their performance in this area. Practitioners must understand that moral reasoning should be ethical. It implies that the premises and assumptions, both inferred and factual, utilized to make decisions should be made explicit and known. In addition, the factual evidence provided to back up an individual’s judgement should be precise, complete, and applicable. However, producing baseless evidences that are hardly convincing could derail the attempts to explain why one takes a particular course while disregarding other forms. Also essential is that ethical standards utilized in reasoning should be consistent at all times. Dimitrios et al. (2020) contend that when inconsistencies are identified in a nurse’s way of making decisions, it is necessary to modify one or more of the standards. Therefore, applying ethical reasoning depends on the measures nurses take to excel in this area.
In addition, adherence to nursing ethical theories is a critical requirement for all nurses who wish to excel in ethical reasoning. The theories serve as the foundation of ethical rules and act as a basis for decision-making (Kangasniemi et al., 2015). The theories offer a rationale that describes the rules and frameworks in order to offer a structured framework for ethical reasoning. Consequently, nurses who wish to improve their ethical reasoning must be conversant with the various theories that guide workers in this field. In addition, it is essential to know what each of the theories require and be able to determine whether a specific framework works best for an individual compared to others (Kangasniemi et al., 2015). Being able to make the comparison allows a nurse to choose the theory that best suits their needs and makes it easy to apply them at the workplace. Consequently, being able to make the right choices based on ethical theories increases the likelihood for attaining the targeted aspirations, and makes it easier to offer services that impress the client.
Autonomy and beneficence are some of the ethical theories that define how nurses conduct their work, including engaging in decision-making. Autonomy is the acknowledgement by practitioners that every patient has the power and right to make their own choices guided by their values and beliefs. Whereas it is likely that a patient’s need for autonomy could clash with care suggestions or guidelines, or what other health workers think is the most appropriate, it is essential to acknowledge that a patient has the right to disagree with medication, surgery, treatment, or other medical practices regardless of what gains may emerge from it. If a client chooses not to pursue a treatment that could possibly offer a benefit, the specialist must respect the decision (Kangasniemi et al., 2015). On the other hand, nurses have an obligation to stay away from actions that could cause harm or maltreatment, and encourage good towards the people they serve. The obligation is in accordance with the ethical principle of beneficence. Nurses show this by offering a balance of gains against threats to the one receiving care. Kangasniemi et al. (2015) assert that helping patients with the tasks and duties that they are not able to do on their own, erecting features to prevent falls in the hospital setting, or offering medication in a quick and timely way are all illustrations of beneficence. Nurses in Singapore and other jurisdictions for that matter have an obligation to abide by these directives in a bid to indulge in ethical reasoning.
Justice and non-maleficence are equally important ethical theories that determine how nurses perform their activities and make decisions that impact on their practice. The theory of justice implies that every patient has the right to be treated equally and fairly by others, particularly nurses (Kangasniemi et al., 2015). However, certain issues that could derail the attempts to do justice. For example, lack of health cover for some patients raises concern on whether it would be possible to provide justice for every patient. Often, those with healthcare insurance would get priority while their counterparts without cover may be exposed to lack of services, thus causing injustice. Another scenario is with people in remote areas who may not easily access the same facilities and services that are available in urban and metropolitan places. Other factors that could derail justice, include but not limited to individual’s race, sexual orientation, religion, political affiliation, ethnicity, and gender among other factors (Kangasniemi et al., 2015). Unfortunately, such segregations have adverse implications on service delivery and contravene ethical requirements. On the other hand, non-maleficence implies that nurses should focus on not harming the patient as much as possible. Consequently, nurses must ensure that patients constantly take their medication, as well as make sure that life support is fitted properly and works effectively in patients who need the machine for survival. The need to abide by the directives of non-maleficence puts nurses in a morally puzzling situation because this ethical guideline is the most challenging to follow (Kangasniemi et al., 2015). These ethical guidelines are imperative and all nurses who wish to improve their practice must follow them.
In addition, it is possible to indulge in ethical reasoning by observing other theories of ethics that impact on the practices of healthcare providers. These are principlism, virtue ethics, deontology, and utilitarianism. Being conversant with these theories can have a number of important gains, which have the capacity to influence and inform the care of clients, countering inappropriate practice, and lead service providers to become more informed about areas that cause disagreement. Rodger and Blackshaw (2017) argue that whereas principlism is not entirely an ethical framework, it is the widely utilized moral guide for directing practices in healthcare, and is evidently applicable to healthcare assistants. The four ethical principles associated with principlism – justice, non-maleficence, beneficence, and autonomy, are framed upon common ethical practice, which identifies the forms of moral acts most individuals recognize as having importance and relevance to their ethical being. The strength of principlism is that the four regulations are based upon what Rodger and Blackshaw (2017) refer to as common morality. Nurses while conducting their operations, including indulging in decision-making abide by the provisions of virtue ethics, which is deemed to be one of the oldest ethical frameworks in nursing practice. It actually traces its origin to the times of Aristotle during the 4th century BC and was later improved by Thomas Aquinas during the 13th century. In the past decades, the theory has become increasingly applicable and is now deemed to have credible applications for those serving in the frontline of healthcare delivery. What makes virtue ethics different from the rest is that it is less focused on what people do or their actions and tend to pay more attention to what becomes of people over time (Rodger & Blackshaw, 2017). The chief requirement is to develop appropriate character because this increases the possibilities of acting in the right manner. Furthermore, virtue ethics demands that a person should strive to become the right type of person by aiming at acquiring particular values, and choosing to indulge in particular acts over others. Thus, practitioners who seek to improve their ethical reasoning and overall practice should abide by the identified ethical theories.
Nurses are likely to make ethical choices that impact positively on all parties by abiding by the concepts of utilitarianism that is equally important in determining how nurses conduct their operations. Utilitarianism is a widely utilized and applied ethical theory that is expansively accepted as the commonest form of consequentialism, a category of moral theories that are largely focused on the implications of one’s actions – whether they result in the targeted outcomes. In essence, the end justifies the means in utilitarianism (Hayry, 2020). In this ethical theory, morally upright acts are those that generate an escalation in states and feelings such as well-being, happiness, or pleasure, called utility. Actions according to utilitarianism are not perceived good in themselves, but only desirable when they impact on (improve) utility. In other words, utilitarianism implies that an act is deemed right if it generates more pleasure than pain, and morally incorrect if it causes more displeasure than happiness (Hayry, 2020). Morally upright acts according to the theory are those that impact on utility, and increase it for every party, not just specific individuals, and is often depicted as the greatest happiness for most of the people. Nurses consider this framework to be essential in guiding their practice because of its simplicity. Hayry (2020) writes that as a single framework to guide individual actions, it can adequately respond to any moral concern. It also appears to get to the bottom of what people believe morality should be about – encouraging human progress and alleviating suffering. Nonetheless, it is essential to consider some of the potential limitations associated with utilitarianism to avoid inconveniences during application. Critics believe that it is difficult to measure the maximum utility for a particular act (Hayry, 2020). For instance, it is unclear whether it is suitable for a person to have a substantial escalation in happiness, or for many people to have a slight increase in happiness. It is also hard to predict the outcomes for a particular act and the implications for a given act and the implications people anticipate do not materialize in all scenarios. Hence, being conversant with utilitarianism while focusing on both the strengths and weaknesses increase the likelihood for acting ethically in all that nurses do.
Equally important in making ethical decisions as a nurse is deontology. The framework puts much emphasis on the connection between morality and duty of human actions. According to this directive, health practitioners have the obligation to abide by the guidelines that define practices and conduct in the profession (Tabarcea, 2012). Thus, nurses should follow regulations in their practice such as respecting patients’ desires, protecting the client’s dignity, and upholding confidentiality. The theory impacts significantly on nursing practice and those serving in various positions should be familiar with its provisions.
Code of Conduct
The existence of a code of conduct in various health facilities contribute significantly towards a reduction in unethical practices and boosts ethical reasoning. The framework often contains a series of statements that put together define what good actions by nursing practitioners look like. A code of conduct usually puts the patients’ desires and interests first. It also encourages safety, encourages trust, and fosters effectiveness (Toumava et al., 2021). A well-formulated code of conduct defines the workplace behavior, and advocates for respect for every person. In addition, a code of conduct should urge members to be unbiased and honest in all their practices. A code of conduct that some refer to as a code of ethics that is likely to give the best results is one that emphasizes on veracity, fidelity, and accountability that are all essential in nursing practice (Toumava et al., 2021). In addition, a code of ethics encourages human relationship, precision, professional competency, and sympathy among other factors that facilitate service delivery and engagement with others. An adequately formulated code of conduct also offers the basis upon which individual practitioners’ capacity to serve is determined if it is exposed to criticism, which is usually the leading feature that many people relate with the code. Thus, facilities that have a code of conduct increase the chances of their nurses making ethical decisions that are not likely to cause controversies and disagreements. Consequently, nursing leaders should consider improving on existing structures on formulating guidelines in workstations that lack this vital structure.
The Singaporean Nursing Board developed the Code for Nurses and Midwives that all nurses in the country must follow. The directive has a total of ten principles that nurses must follow in the course of their activities. For example, Principle 1 calls for respecting people’s values, rights, and needs, while Principle 2 advocates for respecting and promoting people’s autonomy (Singaporean Nursing Board, 2018). Furthermore, Principle 3 advocates for respecting the privacy and confidentiality of all clients. Principles five through ten cover nurses/midwives and their activities, nurses/midwives and their profession, and nurses/midwives and co-workers (Singaporean Nursing Board, 2018). Consequently, being conversant with the provisions increase the likelihood for indulging in ethical reasoning.
Recommendations
Nurses would be able to follow existing legal directives and act in accordance with ethical frameworks when they are aware of how such provisions work. Nurses need knowledge and awareness regarding the structures that determine their work to be in a position to follow all guidelines. The most effective approach in this case is to offer relevant training that would familiarize workers with all necessary factors they need to know. The training process should inform trainees the laws they need to know as they apply in the Singaporean context, and possibly make them know whether particular international regulations could influence their practice. The training practices should also familiarize trainees with relevant ethical theories and help them make choices on the frameworks that suit them the most. On the other hand, individual practitioners should take the initiative to acquire relevant information from reliable sources that would increase how they act in accordance with the theories. They can acquire a wide range of information from online sources that contain so much about how to act ethically as a nurse. Also important is that organizational leaders should be able to create effective and comprehensive code of conduct that would lead nurses towards the right path. It is necessary to familiarize service providers with these directives while ensuring that they adhere to all aspects.
Conclusion
The study reveals that nurses must abide by existing laws as well as conduct their operations in accordance with existing theoretical guidelines. The study identifies the applicable laws that define nursing practice, and shows how compliance increases the chances of achieving targeted outcomes. The analysis identifies laws such as the Nurses and Midwives Act of 1999 that impact on both nurses and midwives. In addition to adhering to laws that guide nursing activities, the report shows that adhering to ethical theories increases the possibilities of making choices that are not likely to generate controversies. Some of the key ethical theories that all nurses must know to increase their capacity to make ethical-based decisions are autonomy, beneficence, non-maleficence, and justice. Autonomy requires nurses to allow patients to make decisions that suit their needs and interests, while beneficence advocates for being charitable and kind, which requires obligation on the nurse’s part to benefit those seeking various health services. Non-maleficence and justice are equally essential, and they advocate for not doing any harm to the patient and offering care without any segregation whatsoever, respectively. Nurses who seek to improve their decision-making should also adhere to other ethical theories that determine how nurses ought to perform their duties. They include utilitarianism, virtue ethics, principlism, and deontology. The study also reveals that nurses are more likely to act ethically by following a code of conduct that hospital administrators usually create to guide service providers. The code of conduct should emphasize on actions and practices that foster relations and encourage appropriate service delivery. The study provides recommendations that may help nurses to abide by existing laws and theories. It emphasizes the need to train workers and ensure that they are familiar with the legal and ethical provisions that determine how they perform their work. Individual practitioners can also perform individual researches and find out what it takes to achieve impressive results when offering care. Nonetheless, non-compliance to legal provisions and failing to follow ethical theories could affect outcome and possibly deter patient satisfaction.
References
Dimitrios, T., Antigoni, F., Kotrotsiou, S. (2020). Special article ethics and deontology in nursing research: A discussion paper. International Journal of Caring Sciences, 13(2), 1467-1473. https://www.researchgate.net/publication/344321160_Special_Article_Ethics_and_Deontology_in_Nursing_Research_A_Discussion_Paper
Hayry, M. (2020). Just better utilitarianism. Cambridge Quarterly of Healthcare Ethics, 30(2), 1-25. doi:10.1017/S0963180120000882
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: An integrative review. Journal of Advanced Nursing, 71(8), doi:10.1111/jan.12619
Rodger, D., & Blackshaw, B. (2017). An introduction to ethical theory for healthcare assistants. British Journal of Healthcare Assistants, 11(11), 556-561. https://philarchive.org/archive/RODAIT-2n
Singapore Statutes Online. (2022). Nurses and Midwives Act 1999. Retrieved April 19, 2022, from https://sso.agc.gov.sg/Act/NMA1999
Singaporean Nursing Board. (2018). Code for nurses and midwives. Retrieved April 19, 2022, from https://www.healthprofessionals.gov.sg/docs/librariesprovider4/publications/code-for-nurses-and-midwives-april-2018.pdf
Tabarcea, A. (2012). The “deontological reflex” and its implications on organizational environment. Procedia – Social and Behavioral Sciences, 62, 981-988. doi:10.1016/j.sbspro.2012.09.167
Toumava, K., Haviernikova, L., Kimmerova, J., & Hellerova, V. (2021). The importance of ethical code in nursing care. Kontakt, 23(2), 1-7. doi:10.32725/kont.2021.021