The content of advocacy in procedural pain care – patients’ and nurses’ perspectives
The purpose expressed by the authors of this article stand out clearly as to outline the understanding of both patients and nurses when it comes to Advocacy in Procedural Pain Care (APPC). To achieve this, otolaryngology (ear, nose and throat) patients, were interviewed as they experience procedural pain and need nursing advocacy because of difficulties with communication accompanied by autonomic problems.
Vaartio, H. et al. (2008). The content of advocacy in procedural pain care –patients’ and nurses’ perspectives. Jan original research journal. 17(2).
Vaartio et al., (2008), indicated that after an unbiased study, it was found that advocacy is a three-part procedure including the antecedents, activities and consequences of advocacy. For proper APPC at clinical level, the patient’s preferences must be understood and met by his nurses. At the therapeutic level, APPC entails counseling the patient about pain care and responding to their self-determination preferences. From these two levels, the key to successful APPC is to first understand the patient’s needs. Patients, unlike nurses, attached importance to patient-nurse relationships, an antecedent of APPC. Nurses, however, put emphasis on their own role identification. This difference strains the achievement of successful APPC. Nurses should understand their ethical duties so as to administer proper APPC. A nurse’s personality is considered key in the kind of APPC a particular nurse administers. From the results, lack of interest in the analysis of self-determination preferences among young patients, unlike those at or above 50, and most of the nurses strains successful APPC. This gives the impression that life experiences shape one’s desire for self empowerment. Response to self-determination seemed better among highly educated patients and nurses with influence over pain care plans and/or high job motivation. Another constraint was that the nurses considered pain care as their responsibility sidelining the patient’s preferences. This is considered a lack of virtue and professionalism on the nurses’ part. Nurses with good pain care skills and female patients preferred counseling as part of APPC. This results in patient and nurse personal empowerment in both pain care and self determination.
Relevance of the ideas
The above insights help in the establishment of nursing advocacy as the two parties involved are considered with equal importance. The findings could also be used to set standards of what could be considered good APPC. This way, nurses’ advocacy and pain care skills can be evaluated and improved.
Utilitarian and common-sense morality discussions in intercultural nursing practice
To discuss how nurses can deal particularly with the dilemmas of how far they can go to honor the extraordinary demands of ethnic minority patients and who needs single rooms more; ethnic minority patients with many visitors due to great need of familial support, or those very ill or dying? Discussion is based on utilitarianism and common-sense morality theories of ethics.
Hanssen, I. & Alpers, L. (2010). Utilitarian and common-sense morality discussions in intercultural nursing practice. Nursing Ethics journal. 17(2).
Hanssen & Alpers (2010) indicated that nurse-patient problems in intercultural nursing arise due to differences in traditions, norms and situational understanding. These conflicts cause moral stress and stress of conscience to nurses. Two main concepts of ethics exist: the right and the good. The good is maximized by the right. Utilitarianism, explains that nurses try to maximize the good by prioritizing demands of the neediest patient. In common-sense morality, the feeling of right or wrong (conscience) is the guiding factor. Both theories were used by the nurses due to the practicality of their setting. The dilemma in ‘who need single rooms more?’ arises as nurses want to respect a patient’s cultural integrity and at the same time, meet all other patients’ needs. This problem could be traced back to the hospital’s healthcare policies and organization. Guidelines that nurses may use in decision-making include; Would the ethnic minority patient benefit more from familial support or simply adequate rest?; Can I defend my decision to myself and both groups of patients? Nurses could decide that the greater gain of some would make up for the losses of others-utilitarianism or use emotion to enhance sensitivity to patients’ needs then make a decision-common-sense morality. In the question of how far to comply to demands, decision-making mostly depended on how busy the ward is and staffing. Here, the greater need (utilitarianism) is related to the resources available. Conscience (common-sense) challenges nurses to fulfill patients’ demands. Discussion with colleagues and insights from colleagues from patient’s culture could help.
The findings could be used to improve intercultural nursing by sensitizing ethnic minority patients on the dilemmas nurses face when dealing with these issues so they could be more understanding. Also, nurses should learn various aspects of culture so as to make informed decisions. Hospital organization in construction and staffing should also be improved to help nurses in such dilemmas.
Whistle blowers: Troublemakers or Virtuous nurses
To discuss moral values of whistle blowing as well as to justify it. The article further discusses available legal protections against negative consequences of whistle blowing.
Lachman, V. D. (2008). Whistleblowers: Troublemakers or Virtuous Nurses? Medsurg nursing journal. 17(2).
Lachman (2008) indicated that whistle blowing is a form of advocacy. In this case, by nurses, to protect the patient from looming harm concealed by the hospital’s management. Concerns can be voiced either outside (whistle blowing) or within (reporting) the organization. The nurse can result to whistle blowing only when the organization fails to resolve a potentially harmful situation especially one that needs immediate attention or that is fatal. Whistle blowing should be applied only when all other possible options are exhausted; this is when it is morally right. One should also give reasonable amount of time to see if changes will be made before whistle blowing. It is a personal initiative and so a whistleblower must be comfortable before taking the step. Virtuous whistleblowers are usually above average performers committed to their organization with very strong ethical values. Various theories justify whistle blowing. Kantian theory justifies whistle blowing by emphasizing the value of telling the truth. Virtue theory promotes courage and integrity. Utilitarianism focuses on maximizing the good. It’s supported by the Standards theory that explains when whistle blowing is ethically necessary for the greater good. Negative consequences of whistle blowing include; difficult working conditions, loss of job, opposition, assassination, questioning of mental stability, official reprimand and long biased court proceedings. The US Constitution warns against retaliation towards the whistleblower. Federal legislation also protects whistleblowers with clear cut good intentions. The National Whistleblower Center helps in advocating for proper service delivery and accountability by various organizations.
Since the article sensitizes us on the legislature in protecting genuine whistleblowers, one is required to know his rights and required procedures before blowing the whistle. This article is also relevant in that it provides a clear cut distinction between virtuous nurses and sheer troublemakers among whistleblowers in our profession. Virtuous whistleblowers will first go through the right channel to report an offensive situation before going public when no solution is offered. In addition, their intentions are only for the greater good and not selfish gains. A troublemaker however, has absolutely no moral guidelines for whistle blowing.