NURISNG ETHICS AND PRINCIPLES : A MILLIEU IN CONNECTING 21ST CENTURY NORMS AND CULTURE by Nurse SUNMBOLA PAUL
NURSING ETHICS AND PRINCIPLES: A MILLIEU IN CONNECTING 21ST CENTURY NORMS AND CULTURE.
PAPER PRESENTED BY NURSE SUNMBOLA PAUL (RN, BNSC)
School of Nursing, Federal Medical Centre, Ido Ekiti, Ekiti State.
AT THE ANNUAL NURSES WEEK ORGANISED BY SEVENTH DAY ADVENTIST STUDENT NURSES ASSOCIATION ILE IFE.
INTRODUCTION
A Nurse is a person who has successfully undergone the prescribed educational programs as stipulated by the regulatory body in any country and as such can be legally called a nurse.
It is a word protected by law in many countries. It is only those whose names appears on the central register that are covered by the law.
There are lots of quacks out there who are not covered by the law, neither do they know about nursing ethics and principles of the nursing profession, no wonder the basterdizing of our noble profession by these set of people, they have nothing to protect or loose, but you have your license to protect.
Ethics has been integral to the nursing profession from its earliest beginnings, when Florence Nightingale and other early pioneers articulated the ethical foundations of nursing practice. This foundation is vital for the future of nursing as the profession rises to the challenges of a rapidly evolving health care sector.
ETHICS: are rules of conduct recognized in respect to a particular class of human actions or a particular group.
The American Nurses Association wrote the code of ethics for nurses, in order to serve the following purposes, which is equally applicable to Nigeria.
As a statement of the ethical obligations and duties of every person who chooses to enter the profession of nursing.
To act as the nonnegotiable standard of ethics
To serve as an expression of the understanding on nursing’s commitment to society.
The code of ethics is a dynamic document that is constantly changing and it is synonymous to your Student’ Hand book in schools of Nursing.
As the morals and values of society change, the documents changes to reflect those morals and values as reflected in the topic before us today.
Today, the need for nursing care is universal within the provision of nursing care are basic inherent principles that provide the frame work for nursing practice.
The International Council of Nurses’ Code of Ethics is grouped into four distinct areas, these four distinct areas define the responsibilities of the individual nurse and nursing as a whole. The four areas are:
To promote health
To prevent illness
To restore health and
To alleviate suffering.
Nursing also embraces human right and provides care without regard to conditions of race, culture, religion or political affiliations. In nursing, the patient may be an individual, a family or a community.
There are about eight provisions that should guide the practice of a nurse:
I. RESPECT FOR HUMAN DIGNITY
The nurse respects the belief and customs of the individual, family or community. The nurse takes into account the values and needs of all persons in the professional relationship. The nurse establishes therapeutic relationships with patients and administers nursing care that respects the unique differences of the patient. This includes considerations of lifestyle (transgender, gay, lesbianism, smokers and alcoholics etc) value system, religious beliefs, or political affiliations. Respect for the values and beliefs of the patient does not imply that the nurse condones those beliefs or practices on a personal level.
Also, the nurse does not allow the disease, disability or functional status of the patient to determine the individuals worth. The nurse respects the rights, dignity and worth of all those who require nursing services for support, comfort, health restoration, or health promotion and prevention.
Respect for human dignity requires that the nurse acknowledge and understand that the patient has certain rights and one of the foremost rights is the right to self-determination (autonomy). Patients have the right to decide what is to be done with and on their own person, and part of that right involves the right to have the information and facts necessary to make an intelligent and enlightened decision regarding health care decision making. The nurse should uphold and encourage the participation and planning of the individual in the decision making process to the extent that they are willing and able to participate. The nurse also engages in the collaboration with others to ensure the provision of quality healthcare services.
II. COMMITMENT OF THE NURSE TO THE PATIENT WHETHER INDIVIDUAL, GROUP OR COMMUNITY
The paramount interest of the nurse is in provision of unique care that is based upon the needs of the patient. The nurse may frequently encounter situations where conflicts of interests exist, this is different from ethical dilemmas. The nurse never exploits the patient for any type of personal gain, whether it be financial or psychological. When the nurse perceives a potential conflict of interest, he/she should reveal the potential conflict to all pertinent parties and in some instances, remove himself/herself from the situation, as is been practiced among legal practitioners to avoid bias.
Professional boundaries should be set at all times. The intimate nature of nursing often presents challenges as nurses share problems and difficulties with patients that can be quiet stressful. The nurse strives to maintain appropriate professional boundaries at all times to avoid compromise of the therapeutic relationship. (I had personal issues as a student that bordered setting professional boundaries in the care of two of my patients, one was having diabetes mellitus and the other breast abscess). Nurse-patient and Nurse-colleague relationships differ from unstructured personal friendships which could lead to circumstances in which professional boundaries can become blurred or distorted. When the nurse finds that the professional boundaries are becoming endangered, she/he should seek assistance from peers or supervisors or seek to remove themselves from the situation. If you are not careful you could have unsolicited friends on your social platforms who could be stalking you on the virtual community.
III. PROTECT THE HEALTH, SAFETY AND RIGHTS OF THE PATIENTS
The nurse acts as an advocate for the patients right to privacy, the need for medical care does not justify unwanted intrusions into a patients privacy (especially in the O & G, needless numbers of virginal examinations should be avoided).
The nurse should ensure that information is revealed in an ethical manner and on a need to know basis within the bounds of the law and patients permission. With regards to public health, or the safety of others, the nurse may have to reveal information for the greater good within the bounds of the law. The nurse should also be there to protect the patients in research. The nurse should be aware that conflicts may arise from research conducted upon vulnerable groups of individuals such as mentally ill, children, prisoners, students, the poor and the elderly. Nurses have a duty to question, report and refuse to participate in research that they deem morally objectionable.
IV. RESPONSIBILITY AND ACCOUNTABILITY
Nurses are responsible for their own practice and the care that their patients receive. Nursing practice include acts of delegation, research, teaching and management. Nurses practice within a framework or morality that values self-determination, respect and dignity. Nurses are accountable for their actions and inactions within this framework, irregardless of institutional policies or procedures.
Nurses who work in an administrative capacity have no direct contact with a patient but still are responsible for the nursing care received by the patient due to the supervising duties that they have with regards to the employee giving the direct care. Nurses must not allow others to perform nursing care which is prohibited by nursing standard.
V. COMPETENCE AND CONTINUING PROFESSIONAL GROWTH
Nurses have the same moral obligation to self as they do to others. The nurse must maintain self-respect, professional growth and competence, wholeness of character and personal integrity. Competence affects ones self-esteem, self-worth, professional status and gives meaning to work. Nursing is held to the highest standards through peer review and self-evaluation. This continuing competence requires a commitment to lifelong learning and an awareness of ongoing issues and changing standards in the practice of professional nursing.
Concerning the nurse character, nurses have both personal and professional identities which are not totally integrated nor totally separated. Within the process of becoming a professional, the nurse embraces the values of the profession and integrate them within personal values.
IV. THE NURSE FACILITATES THE IMPROVEMENT OF THE HEALTHCARE ENVIRONMENT
She does this firstly on moral virtues and values, which are habits that influence people to do what is right, excellence is the habit that predisposes a person to perform a task well. Virtues and excellence can be nurtured or hindered by the environment.
All nurses have a responsibility for creating, maintaining and fostering environments that are supportive towards nurses meeting their ethical obligations. Elements that can either be barriers or foster ethical practice includes incentive programs, disciplinary polices, health and safety programs and organizational structure. Environment which allow for grievance procedure and the fair and the equitable treatment of nurses foster the performance of nursing care according to standards.
Nurses should not condone nor agree to unsafe practices, to do so is paramount to condoning the practices. Nurses should not remain in employed facilities which violates patient rights or participate in unsafe practices.
VII. ADVANCEMENT OF THE PROFESSION THROUGH CONTRIBUTIONS TO PRACTICE, EDUCATION, ADMINISTRATION AND KNOWLEDGE DEVELOPMENT
Through active involvement in nursing and healthcare policies, monitoring roles, leadership positions or on professional committees. Research contributes to the body of knowledge which supports and advances nursing practice.
VIII. COLLABORATION WITH THE PUBLIC AND OTHER HEALTH PROFESSIONALS IN PROMOTING COMMUNITY, NATIONAL AND INTERNATIONAL EFFORTS TO MEET HEALTH NEEDS
We are committed to promoting the health, welfare and safety of all people. You have an obligation to be aware of not only the health needs of individuals, but also the broader global health issues such as world hunger, proper sanitation, clean drinking water, safety issues relating to terrorism, disasters etc. you must be aware of the threats to individual health and the community as a whole. Through community support and participation, nurses are able to educate the public about threats to individuals and community health and safety and impart necessary knowledge to assist informed decision making regarding those threats.
Nurses also support initiatives to remove barriers to health and Safety such as violence, poverty and homelessness. The nurse recognizes that the community is a culturally diverse mix of individuals and thus does not impart or impress his/her values upon others with values which differ.
BRIEF HISTORY OF WORLD AGES AND CENTURIES
Prehistory period: before documented history
Ancient history: roughly 5000 years ago
Post classical history: AD 200-600 and AD 1200-1500
Middle ages also known as age of discovery. Here we also have the early middle ages and late middle ages.
Modern history
Early modern history
Late modern history
Machine age 1880-1945
Age of oil (after 1901)
World war 1914 - 1918
Inter war period 1918-1939
Great depression 1929- world war II
World war II 1939 -1945
Post war ear 1946-1962
Space age (after 1957)
Post modern history (Soviet Union and United States 1973- present)
Information Age 1970-present (also known as the Computer Age, Digital Age, or New Media Age) is a period in human history characterized by the shift from traditional industry that the Industrial Revolution brought through industrialization, to an economy based on information computerization. The onset of the Information Age is associated with the Digital Revolution, just as the Industrial Revolution marked the onset of the Industrial Age. The definition of what digital means (or what information means) continues to change over time as new technologies, user devices, methods of interaction with other humans and devices enter the domain of research, development and market launch.
During the Information Age, the phenomenon is that the digital industry creates a knowledge-based society surrounded by a high-tech global economy that spans over its influence on how the manufacturing throughout and the service sector operate in an efficient and convenient way. In a commercialized society, the information industry is able to allow individuals to explore their personalized needs, therefore simplifying the procedure of making decisions for transactions and significantly lowering costs for both the producers and buyers. This is accepted overwhelmingly by participants throughout the entire economic activities for efficacy purposes, and new economic incentives would then be indigenously encouraged, such as the knowledge economy.
The Information Age formed by capitalizing on computer microminiaturization advances. This evolution of technology in daily life and social organization has led to the fact that the modernization of information and communication processes has become the driving force of social evolution.
Social age 1996- present encompasses both societal and technological changes succeeding the Information Age.
It is divergent from the Information Age as it gives more prominence to social factors when adopting and/or extending technology and information. It further broadens the definition of Attention Age because the Social Age focuses on many forms of societal interactions including online relationships, collaboration and sharing.
Multimedia age 1987- present
Nuclear age 1950- present
Contemporary history: this is history within living memory. It shifts forward with the generations.
From the above table we observe we are in the post modern age and particularly information age mixing up with the social age.
Health care, conceived broadly as institutionalized as well as non-institutionalized forms of tending to sickness and health, is undergoing transformations at a high speed and with unprecedented outcomes. Accelerated global flows of medical goods and services, ongoing economization of health, demographic changes and the ‘greying’ of societies as well as new and re-emergent pandemics affects the healthcare landscapes in the 21st century.
Moreover, the ready availability of vast health information via the internet and social networks contributes to and is rapidly changing healthcare constellations. Also the readiness of legal practioners to render services tour patients who are not properly treated in the hospital calls for caution among healthcare workers.
In the 21st century, ages of information technology, we are experiencing a dramatic paradigm shift to knowledge based information society and subsequently witnessed the impact of information technology and emergence of new social norms and ethical values and cultural trends from it. For example, people can make their own personal websites and blogs to share their memories with others, and express ideas to the public. A piece of gossip or personal point of view in the internet, could be grown into a big social issue and public agenda attracting big attention, so be careful what you post online, don’t forget too quickly the issues of patients lost to ebola and public sharing of such information and the impact on the relatives, there could be social stigma. Do not share patients data on social platforms even if they are professional platforms, its unethical to do that.
Cultural changes through information technology have impacted health care in transforming it from the traditional forms of services to the present day, where we hear of ehealth, telenursing, telemedicine, robotics, digital devices, digitalization of human body.
CHANGES IN NURSING ROLES IN THE 21ST CENTURY
The role you play in the provision of medical services, as a nurse, has evolved in the 21st century owing partly to technological advancement in the health sector. Nursing has become a more defined profession because of the modification of health service polices, the advent of new drugs and the treatment methods and the global shortage of nurses.
There are well over 104 nursing specialty programs in the United States, depending on your specialty in nursing, nurses roles have broadened to include ordering laboratory tests after diagnosing a patient, carry out therapy management and prescribe medication, making medical referrals, conducting physical examination and assessments, nurses design, implement and evaluate academic curriculum.
The increased roles of nurses within the 21st century healthcare system stems from efforts made by nurses umbrella bodies, which have helped create a nationally accepted nursing practice standards in USA.
What is Known about ethical issues in the 21st century?
System, provider, and patient factors influence ethical issues in nursing clinical practice, and these issues are increasing in both diversity and complexity
There are both emerging and persistent ethical issues for patients from vulnerable groups and with specific diagnoses (e.g., mental disorders, physical disabilities, certain infectious diseases)
Population aging, globalization, technological innovation, advances in screening and genetic science create new and complex dilemmas for nurses
Increasing recognition of the social determinants of health as moderating health outcomes creates new challenges in access and acceptability of health care interventions
Many ethical issues occur among critically ill patients at the two extremes of the age spectrum – the very young and the very old
Nurses may experience role conflict and ambiguity in practice settings
Electronic medical records and the analysis of massive patient data sets raise concerns about privacy, confidentiality, and data sharing
Nurses play a key role in patient advocacy and monitoring health outcomes and are leading empirical work in addressing ethical challenges and providing a voice for patients and their families
Moral distress appears widespread among nurses and is present in nearly every work environment, while sources of resilience and problem-solving skills can lead to moral courage
Ethical problems encountered when practicing as a student nurse included concerns about using patients as teaching material, making ethical decisions in practice settings, students’ observation of ethical problems, and concerns regarding using social media and relationships with pharmaceutical reps
Students in the clinical setting are unprepared to address ethical issues and tend to defer to staff nurse recommendations when making ethical decision in clinical settings, even if the advice contradicts best-practice standards
Student nurses’ limited clinical skills, lower status, and reticence lead to frustration, feelings of powerlessness, and silence
What knowledge needs to be developed?
Negotiation of ethical principles and values in an increasingly diverse and pluralistic society and articulation of how these relate to nursing practice in the digital age
Reconcile ethical values and principles that undergird nursing practice with legal, social, religious/spiritual, cultural, and other frameworks
A more robust model of moral agency in nursing, including the knowledge, skills, and internal capacities that are needed to create self-awareness, self-respect, and effective advocacy
Methods to recognize moral distress, identify root causes, and develop a wide variety of interventions to help prevent and mitigate it
Advancement of nursing science to increase the number of interventions that are tailored and targeted to specific populations and ethical issues
Consideration of ethical issues for nursing within a context of system, clinician, and patient factors
Global factors, such as climate change and increasing pandemics, require a coordinated and integrated response, including nurses as part of the dialogue and decision-making
The adequacy of current ethical education content for advanced nursing students (e.g., nurse practitioner, clinical nurse specialist, and doctoral students) is unknown
More studies are needed to explore emerging topics such as the impact on students of educators’ ethical behavior in the classroom and problems with social media
While some researchers advocate inter-disciplinary ethics education, more evidence regarding similarity of need, as well as class design, outcome, and feasibility is needed
Best practices for ongoing professional development and maintenance of ethics knowledge within the active nurse workforce
Research is needed to understand the adequacy and content of ongoing education for practicing nurses
CONCLUSION
One thing for sure is that information technology would serve as a catalyst for changes of societies and cultures and the development of new ways of life, which act as positive or negative momentum, depending on how we see or use it.
To create positive momentum, it is essential to fully understand the influence and results of socio cultural changes by information technology and predict the direction of the changes.
Unfortunately, however, such changes have been unfolded in a rapid and diverse way, for which reason we cannot have a clear picture of future digital society and may feel uneasy about it.
However, since finding out where we are and where we are going may guide us to a better future digital society, understanding such changes and setting a direction would be necessary and prerequisite for the consistent and reliable future of internet and digital information society as it affects nursing and healthcare industry.
On a final note I wish to share with you the words of Dr. Jack Cochran who said that For most of history, health care was centered around the doctor’s office or hospital. It was the era of the lone practitioner, the omniscient physician to whom patients turned to treat their ailments. That was the industrial age of medicine.
Today, health care is much more complex. The proliferation of information available to physicians and to their patients has fundamentally shifted the locus of information and power to patients. In the information age of medicine, we must optimize the use of information, technology, tools, and teams. We need to turn masses of patient data, science, and clinical evidence into clinical knowledge. This information must be available to patients, nurses, physicians, and care teams. And they must have access to technology and tools to make the right thing easier to do.
Health care must transform in order to meet the challenges of the information age and to address the crisis of affordability and value in health care. We must become a learning industry. We need to draw from all parts of the industry; harnessing our collective knowledge, working collaboratively, and learning together. We can’t treat our way out of the health care crisis. We must learn our way out of it.
Thank you for listening.
GREAT SEDASNA!!! GREAT
REFERENCES
Harmonized code of ethics for Nurses in Nigeria, 2012
Bernhard Hadolt and Anita Hardon (2007), Emerging socialities in 21st Century Healthcare, Amsterdam University Press
Dr. Inuk Chung (2007) Roles and impacts of IT on new social Norms, Ethical Values and Legal Frameworks in shaping a Future Digital Society.
Ethical issues in health workforce development: a Bulletin of the World Health Organization 2005;83, 280-284
http://www.bioethicsinstitute.org/nursing-ethics-summit-report/literature-review
www.rn.org
http://work.chron.com/changes-nursing-roles-21st-century-22997.html
http://work.chron.com/technology-changed-21stcentury-workplace-18447.html
https://en.wikipedia.org/wiki/Information_Age
https://en.wikipedia.org/wiki/Social_Age
https://www.ischool.berkeley.edu/events/2013/transforming-health-care-information-age
https://www.discovernursing.com/explore-specialties#no-filters
PAPER PRESENTED BY NURSE SUNMBOLA PAUL (RN, BNSC)
School of Nursing, Federal Medical Centre, Ido Ekiti, Ekiti State.
AT THE ANNUAL NURSES WEEK ORGANISED BY SEVENTH DAY ADVENTIST STUDENT NURSES ASSOCIATION ILE IFE.
INTRODUCTION
A Nurse is a person who has successfully undergone the prescribed educational programs as stipulated by the regulatory body in any country and as such can be legally called a nurse.
It is a word protected by law in many countries. It is only those whose names appears on the central register that are covered by the law.
There are lots of quacks out there who are not covered by the law, neither do they know about nursing ethics and principles of the nursing profession, no wonder the basterdizing of our noble profession by these set of people, they have nothing to protect or loose, but you have your license to protect.
Ethics has been integral to the nursing profession from its earliest beginnings, when Florence Nightingale and other early pioneers articulated the ethical foundations of nursing practice. This foundation is vital for the future of nursing as the profession rises to the challenges of a rapidly evolving health care sector.
ETHICS: are rules of conduct recognized in respect to a particular class of human actions or a particular group.
The American Nurses Association wrote the code of ethics for nurses, in order to serve the following purposes, which is equally applicable to Nigeria.
As a statement of the ethical obligations and duties of every person who chooses to enter the profession of nursing.
To act as the nonnegotiable standard of ethics
To serve as an expression of the understanding on nursing’s commitment to society.
The code of ethics is a dynamic document that is constantly changing and it is synonymous to your Student’ Hand book in schools of Nursing.
As the morals and values of society change, the documents changes to reflect those morals and values as reflected in the topic before us today.
Today, the need for nursing care is universal within the provision of nursing care are basic inherent principles that provide the frame work for nursing practice.
The International Council of Nurses’ Code of Ethics is grouped into four distinct areas, these four distinct areas define the responsibilities of the individual nurse and nursing as a whole. The four areas are:
To promote health
To prevent illness
To restore health and
To alleviate suffering.
Nursing also embraces human right and provides care without regard to conditions of race, culture, religion or political affiliations. In nursing, the patient may be an individual, a family or a community.
There are about eight provisions that should guide the practice of a nurse:
I. RESPECT FOR HUMAN DIGNITY
The nurse respects the belief and customs of the individual, family or community. The nurse takes into account the values and needs of all persons in the professional relationship. The nurse establishes therapeutic relationships with patients and administers nursing care that respects the unique differences of the patient. This includes considerations of lifestyle (transgender, gay, lesbianism, smokers and alcoholics etc) value system, religious beliefs, or political affiliations. Respect for the values and beliefs of the patient does not imply that the nurse condones those beliefs or practices on a personal level.
Also, the nurse does not allow the disease, disability or functional status of the patient to determine the individuals worth. The nurse respects the rights, dignity and worth of all those who require nursing services for support, comfort, health restoration, or health promotion and prevention.
Respect for human dignity requires that the nurse acknowledge and understand that the patient has certain rights and one of the foremost rights is the right to self-determination (autonomy). Patients have the right to decide what is to be done with and on their own person, and part of that right involves the right to have the information and facts necessary to make an intelligent and enlightened decision regarding health care decision making. The nurse should uphold and encourage the participation and planning of the individual in the decision making process to the extent that they are willing and able to participate. The nurse also engages in the collaboration with others to ensure the provision of quality healthcare services.
II. COMMITMENT OF THE NURSE TO THE PATIENT WHETHER INDIVIDUAL, GROUP OR COMMUNITY
The paramount interest of the nurse is in provision of unique care that is based upon the needs of the patient. The nurse may frequently encounter situations where conflicts of interests exist, this is different from ethical dilemmas. The nurse never exploits the patient for any type of personal gain, whether it be financial or psychological. When the nurse perceives a potential conflict of interest, he/she should reveal the potential conflict to all pertinent parties and in some instances, remove himself/herself from the situation, as is been practiced among legal practitioners to avoid bias.
Professional boundaries should be set at all times. The intimate nature of nursing often presents challenges as nurses share problems and difficulties with patients that can be quiet stressful. The nurse strives to maintain appropriate professional boundaries at all times to avoid compromise of the therapeutic relationship. (I had personal issues as a student that bordered setting professional boundaries in the care of two of my patients, one was having diabetes mellitus and the other breast abscess). Nurse-patient and Nurse-colleague relationships differ from unstructured personal friendships which could lead to circumstances in which professional boundaries can become blurred or distorted. When the nurse finds that the professional boundaries are becoming endangered, she/he should seek assistance from peers or supervisors or seek to remove themselves from the situation. If you are not careful you could have unsolicited friends on your social platforms who could be stalking you on the virtual community.
III. PROTECT THE HEALTH, SAFETY AND RIGHTS OF THE PATIENTS
The nurse acts as an advocate for the patients right to privacy, the need for medical care does not justify unwanted intrusions into a patients privacy (especially in the O & G, needless numbers of virginal examinations should be avoided).
The nurse should ensure that information is revealed in an ethical manner and on a need to know basis within the bounds of the law and patients permission. With regards to public health, or the safety of others, the nurse may have to reveal information for the greater good within the bounds of the law. The nurse should also be there to protect the patients in research. The nurse should be aware that conflicts may arise from research conducted upon vulnerable groups of individuals such as mentally ill, children, prisoners, students, the poor and the elderly. Nurses have a duty to question, report and refuse to participate in research that they deem morally objectionable.
IV. RESPONSIBILITY AND ACCOUNTABILITY
Nurses are responsible for their own practice and the care that their patients receive. Nursing practice include acts of delegation, research, teaching and management. Nurses practice within a framework or morality that values self-determination, respect and dignity. Nurses are accountable for their actions and inactions within this framework, irregardless of institutional policies or procedures.
Nurses who work in an administrative capacity have no direct contact with a patient but still are responsible for the nursing care received by the patient due to the supervising duties that they have with regards to the employee giving the direct care. Nurses must not allow others to perform nursing care which is prohibited by nursing standard.
V. COMPETENCE AND CONTINUING PROFESSIONAL GROWTH
Nurses have the same moral obligation to self as they do to others. The nurse must maintain self-respect, professional growth and competence, wholeness of character and personal integrity. Competence affects ones self-esteem, self-worth, professional status and gives meaning to work. Nursing is held to the highest standards through peer review and self-evaluation. This continuing competence requires a commitment to lifelong learning and an awareness of ongoing issues and changing standards in the practice of professional nursing.
Concerning the nurse character, nurses have both personal and professional identities which are not totally integrated nor totally separated. Within the process of becoming a professional, the nurse embraces the values of the profession and integrate them within personal values.
IV. THE NURSE FACILITATES THE IMPROVEMENT OF THE HEALTHCARE ENVIRONMENT
She does this firstly on moral virtues and values, which are habits that influence people to do what is right, excellence is the habit that predisposes a person to perform a task well. Virtues and excellence can be nurtured or hindered by the environment.
All nurses have a responsibility for creating, maintaining and fostering environments that are supportive towards nurses meeting their ethical obligations. Elements that can either be barriers or foster ethical practice includes incentive programs, disciplinary polices, health and safety programs and organizational structure. Environment which allow for grievance procedure and the fair and the equitable treatment of nurses foster the performance of nursing care according to standards.
Nurses should not condone nor agree to unsafe practices, to do so is paramount to condoning the practices. Nurses should not remain in employed facilities which violates patient rights or participate in unsafe practices.
VII. ADVANCEMENT OF THE PROFESSION THROUGH CONTRIBUTIONS TO PRACTICE, EDUCATION, ADMINISTRATION AND KNOWLEDGE DEVELOPMENT
Through active involvement in nursing and healthcare policies, monitoring roles, leadership positions or on professional committees. Research contributes to the body of knowledge which supports and advances nursing practice.
VIII. COLLABORATION WITH THE PUBLIC AND OTHER HEALTH PROFESSIONALS IN PROMOTING COMMUNITY, NATIONAL AND INTERNATIONAL EFFORTS TO MEET HEALTH NEEDS
We are committed to promoting the health, welfare and safety of all people. You have an obligation to be aware of not only the health needs of individuals, but also the broader global health issues such as world hunger, proper sanitation, clean drinking water, safety issues relating to terrorism, disasters etc. you must be aware of the threats to individual health and the community as a whole. Through community support and participation, nurses are able to educate the public about threats to individuals and community health and safety and impart necessary knowledge to assist informed decision making regarding those threats.
Nurses also support initiatives to remove barriers to health and Safety such as violence, poverty and homelessness. The nurse recognizes that the community is a culturally diverse mix of individuals and thus does not impart or impress his/her values upon others with values which differ.
BRIEF HISTORY OF WORLD AGES AND CENTURIES
Prehistory period: before documented history
Ancient history: roughly 5000 years ago
Post classical history: AD 200-600 and AD 1200-1500
Middle ages also known as age of discovery. Here we also have the early middle ages and late middle ages.
Modern history
Early modern history
Late modern history
Machine age 1880-1945
Age of oil (after 1901)
World war 1914 - 1918
Inter war period 1918-1939
Great depression 1929- world war II
World war II 1939 -1945
Post war ear 1946-1962
Space age (after 1957)
Post modern history (Soviet Union and United States 1973- present)
Information Age 1970-present (also known as the Computer Age, Digital Age, or New Media Age) is a period in human history characterized by the shift from traditional industry that the Industrial Revolution brought through industrialization, to an economy based on information computerization. The onset of the Information Age is associated with the Digital Revolution, just as the Industrial Revolution marked the onset of the Industrial Age. The definition of what digital means (or what information means) continues to change over time as new technologies, user devices, methods of interaction with other humans and devices enter the domain of research, development and market launch.
During the Information Age, the phenomenon is that the digital industry creates a knowledge-based society surrounded by a high-tech global economy that spans over its influence on how the manufacturing throughout and the service sector operate in an efficient and convenient way. In a commercialized society, the information industry is able to allow individuals to explore their personalized needs, therefore simplifying the procedure of making decisions for transactions and significantly lowering costs for both the producers and buyers. This is accepted overwhelmingly by participants throughout the entire economic activities for efficacy purposes, and new economic incentives would then be indigenously encouraged, such as the knowledge economy.
The Information Age formed by capitalizing on computer microminiaturization advances. This evolution of technology in daily life and social organization has led to the fact that the modernization of information and communication processes has become the driving force of social evolution.
Social age 1996- present encompasses both societal and technological changes succeeding the Information Age.
It is divergent from the Information Age as it gives more prominence to social factors when adopting and/or extending technology and information. It further broadens the definition of Attention Age because the Social Age focuses on many forms of societal interactions including online relationships, collaboration and sharing.
Multimedia age 1987- present
Nuclear age 1950- present
Contemporary history: this is history within living memory. It shifts forward with the generations.
From the above table we observe we are in the post modern age and particularly information age mixing up with the social age.
Health care, conceived broadly as institutionalized as well as non-institutionalized forms of tending to sickness and health, is undergoing transformations at a high speed and with unprecedented outcomes. Accelerated global flows of medical goods and services, ongoing economization of health, demographic changes and the ‘greying’ of societies as well as new and re-emergent pandemics affects the healthcare landscapes in the 21st century.
Moreover, the ready availability of vast health information via the internet and social networks contributes to and is rapidly changing healthcare constellations. Also the readiness of legal practioners to render services tour patients who are not properly treated in the hospital calls for caution among healthcare workers.
In the 21st century, ages of information technology, we are experiencing a dramatic paradigm shift to knowledge based information society and subsequently witnessed the impact of information technology and emergence of new social norms and ethical values and cultural trends from it. For example, people can make their own personal websites and blogs to share their memories with others, and express ideas to the public. A piece of gossip or personal point of view in the internet, could be grown into a big social issue and public agenda attracting big attention, so be careful what you post online, don’t forget too quickly the issues of patients lost to ebola and public sharing of such information and the impact on the relatives, there could be social stigma. Do not share patients data on social platforms even if they are professional platforms, its unethical to do that.
Cultural changes through information technology have impacted health care in transforming it from the traditional forms of services to the present day, where we hear of ehealth, telenursing, telemedicine, robotics, digital devices, digitalization of human body.
CHANGES IN NURSING ROLES IN THE 21ST CENTURY
The role you play in the provision of medical services, as a nurse, has evolved in the 21st century owing partly to technological advancement in the health sector. Nursing has become a more defined profession because of the modification of health service polices, the advent of new drugs and the treatment methods and the global shortage of nurses.
There are well over 104 nursing specialty programs in the United States, depending on your specialty in nursing, nurses roles have broadened to include ordering laboratory tests after diagnosing a patient, carry out therapy management and prescribe medication, making medical referrals, conducting physical examination and assessments, nurses design, implement and evaluate academic curriculum.
The increased roles of nurses within the 21st century healthcare system stems from efforts made by nurses umbrella bodies, which have helped create a nationally accepted nursing practice standards in USA.
What is Known about ethical issues in the 21st century?
System, provider, and patient factors influence ethical issues in nursing clinical practice, and these issues are increasing in both diversity and complexity
There are both emerging and persistent ethical issues for patients from vulnerable groups and with specific diagnoses (e.g., mental disorders, physical disabilities, certain infectious diseases)
Population aging, globalization, technological innovation, advances in screening and genetic science create new and complex dilemmas for nurses
Increasing recognition of the social determinants of health as moderating health outcomes creates new challenges in access and acceptability of health care interventions
Many ethical issues occur among critically ill patients at the two extremes of the age spectrum – the very young and the very old
Nurses may experience role conflict and ambiguity in practice settings
Electronic medical records and the analysis of massive patient data sets raise concerns about privacy, confidentiality, and data sharing
Nurses play a key role in patient advocacy and monitoring health outcomes and are leading empirical work in addressing ethical challenges and providing a voice for patients and their families
Moral distress appears widespread among nurses and is present in nearly every work environment, while sources of resilience and problem-solving skills can lead to moral courage
Ethical problems encountered when practicing as a student nurse included concerns about using patients as teaching material, making ethical decisions in practice settings, students’ observation of ethical problems, and concerns regarding using social media and relationships with pharmaceutical reps
Students in the clinical setting are unprepared to address ethical issues and tend to defer to staff nurse recommendations when making ethical decision in clinical settings, even if the advice contradicts best-practice standards
Student nurses’ limited clinical skills, lower status, and reticence lead to frustration, feelings of powerlessness, and silence
What knowledge needs to be developed?
Negotiation of ethical principles and values in an increasingly diverse and pluralistic society and articulation of how these relate to nursing practice in the digital age
Reconcile ethical values and principles that undergird nursing practice with legal, social, religious/spiritual, cultural, and other frameworks
A more robust model of moral agency in nursing, including the knowledge, skills, and internal capacities that are needed to create self-awareness, self-respect, and effective advocacy
Methods to recognize moral distress, identify root causes, and develop a wide variety of interventions to help prevent and mitigate it
Advancement of nursing science to increase the number of interventions that are tailored and targeted to specific populations and ethical issues
Consideration of ethical issues for nursing within a context of system, clinician, and patient factors
Global factors, such as climate change and increasing pandemics, require a coordinated and integrated response, including nurses as part of the dialogue and decision-making
The adequacy of current ethical education content for advanced nursing students (e.g., nurse practitioner, clinical nurse specialist, and doctoral students) is unknown
More studies are needed to explore emerging topics such as the impact on students of educators’ ethical behavior in the classroom and problems with social media
While some researchers advocate inter-disciplinary ethics education, more evidence regarding similarity of need, as well as class design, outcome, and feasibility is needed
Best practices for ongoing professional development and maintenance of ethics knowledge within the active nurse workforce
Research is needed to understand the adequacy and content of ongoing education for practicing nurses
CONCLUSION
One thing for sure is that information technology would serve as a catalyst for changes of societies and cultures and the development of new ways of life, which act as positive or negative momentum, depending on how we see or use it.
To create positive momentum, it is essential to fully understand the influence and results of socio cultural changes by information technology and predict the direction of the changes.
Unfortunately, however, such changes have been unfolded in a rapid and diverse way, for which reason we cannot have a clear picture of future digital society and may feel uneasy about it.
However, since finding out where we are and where we are going may guide us to a better future digital society, understanding such changes and setting a direction would be necessary and prerequisite for the consistent and reliable future of internet and digital information society as it affects nursing and healthcare industry.
On a final note I wish to share with you the words of Dr. Jack Cochran who said that For most of history, health care was centered around the doctor’s office or hospital. It was the era of the lone practitioner, the omniscient physician to whom patients turned to treat their ailments. That was the industrial age of medicine.
Today, health care is much more complex. The proliferation of information available to physicians and to their patients has fundamentally shifted the locus of information and power to patients. In the information age of medicine, we must optimize the use of information, technology, tools, and teams. We need to turn masses of patient data, science, and clinical evidence into clinical knowledge. This information must be available to patients, nurses, physicians, and care teams. And they must have access to technology and tools to make the right thing easier to do.
Health care must transform in order to meet the challenges of the information age and to address the crisis of affordability and value in health care. We must become a learning industry. We need to draw from all parts of the industry; harnessing our collective knowledge, working collaboratively, and learning together. We can’t treat our way out of the health care crisis. We must learn our way out of it.
Thank you for listening.
GREAT SEDASNA!!! GREAT
REFERENCES
Harmonized code of ethics for Nurses in Nigeria, 2012
Bernhard Hadolt and Anita Hardon (2007), Emerging socialities in 21st Century Healthcare, Amsterdam University Press
Dr. Inuk Chung (2007) Roles and impacts of IT on new social Norms, Ethical Values and Legal Frameworks in shaping a Future Digital Society.
Ethical issues in health workforce development: a Bulletin of the World Health Organization 2005;83, 280-284
http://www.bioethicsinstitute.org/nursing-ethics-summit-report/literature-review
www.rn.org
http://work.chron.com/changes-nursing-roles-21st-century-22997.html
http://work.chron.com/technology-changed-21stcentury-workplace-18447.html
https://en.wikipedia.org/wiki/Information_Age
https://en.wikipedia.org/wiki/Social_Age
https://www.ischool.berkeley.edu/events/2013/transforming-health-care-information-age
https://www.discovernursing.com/explore-specialties#no-filters
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