The nursing practice is premised in ten framework of professional responsibilities , conventions, personal conscience and a framework that also includes legal, religious and philosophical perspective that govern and influence what must be done and how it must as well it must be done in any professional practice. Such a framework often pits nursing in salient ethical dilemmas. An ethical dilemma is defined by Cowley D, (2004) as scenario where in apparent conflict of moral imperatives is present such that adhering to one will result in regressing the other. This has also been reoffered to as ethical paradox. This paper some ethical dilemma experienced in a nursing practice whilst also premising the dilemma in applied theories of social therapy.
Nurses may often ethical dilemmas for instance where they must apply social therapy theories such the Cognitive Behavioral Therapy (also known as cognitive behavior therapy, CBT) in dealing with depression clients where the depression has been characterised y substance abuse. CBT is defined as a psychotherapeutic model designed to influence problematic as well as dysfunctional emotions, behaviors as well as cognition through a goal-focused systematic process.
CBT is often used an inclusive term of reference to other forms of psychological therapy that derive from the theoretical framework from behavioristic learning model as well as cognitive psychology. The term is also used to refer to al methods and approaches of transformation that are based on the theories outlined above. Wetterling T et al (2000) note that CBT therapies have more emphasis on largely cognitive solutions while some of them are rather typically more behavioral. In the application of cognitive oriented therapies the aim is to establish and monitor mind processes, the thoughts, as well examine and monitor the subjects’ assumptions and beliefs and behaviors associated with unhealthy negative emotions.
The process entails the establishment of thoughts and behaviors which are dysfunctional and also meaningful. The salient objective in the application of this processes it to replace these and transcend with identified deformities. Ethical dilemmas arising from the use of this approach in substance abuse related depression may trigger critical ethical dilemmas in the nursing practice where nursing professional have to deal with Rastafarian who use of marijuana as part of their religion culture.
The cognitive Behavioral Therapy said to be concise and straight forward in comparison to other models and approaches in social work. The theory entails the exploration of an established relationship between cognition, emotion and behavior. Tomlinson et al (996) note that the theory is an assortment of short-term ensembles of psychotherapy. The theory which has been hailed for its cross-cultural applicability may fail to suffice for a scenario entailing substance (marijuana) abuse by Rastafarian who would have abuse the substance in the guise of Rastafarian culture to try to quell social and psychological problems.
The core of the ethical dilemmas is that application of the social therapy approaches is aimed at helping the client quit substance abuse which is a moral transgression of the regard of the client’s cultural beliefs and conscience. This is the possible critical dilemma.
CBT focuses on modifying Cognitive distortions. Salient aspects and focus of CBT include dichotomous thinking, mind reading, emotional responses, personalisation and perfectionism. Common CBT interventions entail the focus on the recognition of automatic thoughts, assessment and response variables. The addressing of the clients problems in the premise of the approach will culminate in an ethical dilemma for the nursing professional. The nurse will be plagued with questions such as what is the right thing to do, should I apply substance abuse quitting approaches?, Should I make a Rastafarian go against his/her religious beliefs and make him/her quit marijuana?, etc.
Judith, J Beck (1995) has outlined the following as the useful treatment principles.
- Cognitive treatment based on an evolving formulation of the client situation and client problem in cognitive terms
- The focus on the relationship between cognitive treatment and therapeutic relationship
- Problem-focus as well decisive orientation on goals
Inn practice the CBT model has been applied in scenario demanding a turnaround or total overhaul of a subject’s problem attributes. The model application entail framing up solution to a client’s attitudinal or any other rated problems from the way the person thinks.
This is attributable to the fact that the model holds that our feelings and actions culminate from the way we think. The logic following from that premise is that anything wrong about a person’s conduct is based on their wrong way of thinking. As such the model holds that if the way of thinking of the subjects can be change their behaviors will be turned around for the better as well. Kendall RE (1983), notes that the application of the conceptual make up of this approach will undermine certain through process of certain persons that have thought patterns are strongly influenced by factor such as religion.
This presents a clash of between nursing approach and the regard for moral imperative to treat individuals as cultural beings respecting their culture and moral philosophies. In application the model also sidelines the impact of external factors that constitute a clients’ environment. The application of the model downplays the effects of eternal factor like people, situations as well as events on the behavioral patterns of an individual. Nonetheless the merits of this approach is based on that the change of the way we think can yield a better attitudes and approach to issues even the actual problem scenario has not really changed.
In a case scenario that featured a developing drug addict the social worker established strong links between the conduct of the subjects and social dynamics of the subject. The subject of the despondent worker in a relief work organisation. The subject has harbored a strong desire to pursue a career in law and she has been bullied by the job market to settle for anything that will enable her to sustain her self and her family. The disillusionments have escalated to critical levels for the client. What is the notable is the thrust adopted by the social in applying some demerits of the CBT model in addressing the subject’s dilemmas. Although the social worker was able to initiate a paradigmatic shift in the way the subject has been thinking about her predicament the process triggered some ethical dilemmas of the nurse.
Although the social worker was able to make the subject approach her job with a perspective of drawing fulfillment from being able to take part in activities of saving people’s lives there was profound conflict on whither to help the subject quit marijuana or not. It can be noted in the case scenario that the demerits of attempting to change a person’s way of thinking , even is the situation of the subject has not really changed, become a critical point of moral transgression of the subject’s thought process based on their culture if the subject had to be made to quit marijuana.
Overly more researches are needed to come up with the best points of confluence between theory and practice to ensure that there is a body of knowledge oh how to handle alcohol and drug abuse which will suffice for all cultures and age groups.
The ego-orientated intervention theory holds that the subject scenario will improve if his/her self esteem and ego as well as self-concept are bolstered. The DSM-IV (American Psychiatric Association 1994) outlines that substance abuse is a maladaptive pattern of substance use the results in a clinically significant impairment or distress, as manifested by one or more of the items outlined below;
- Failure to meet major social role obligations at work, school or even in domestic precincts
- Engaging in physically dangerous activities, substance related legal problems, and perpetual substance use regardless of its evident negative personal and interpersonal effects.
Kendall RE (1983) notes that substance because may or may be without psychological dependence. There has been paradigmatic and perspective shift from the view of substance abuse and a negative evil and sinful conduct into more proactivist approaches that seek to understand the dynamism of the problem and find feasible solutions to it.
Health and social work practitioners who have made use of the mental health model in close relation to the Ego-Orientated approach in dealing with the problem of addiction normally regard substance abuse as part of the efforts to implement means of self-medication. This abuse of substance has also been viewed by many practitioners as an expression of a way of handling entrenched personal predicaments. This has made psychodynamically inclined practitioners shift from attacking the abuse problem directly and rather adopt a holistic and far reaching approach in the understanding that the former will would result in the diminishing of the victim’s self-esteem and ego.
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