Ethical Behavior Peer Reviewed Journal

Ethics and Nursing

One of the complexities of 21st century medicine is the evolution of nursing care theories in combination with a changing need and expectation of the stakeholder population. Nurses must be advocates and communicators, but must balance these along with an overall philosophy of ethics while still remaining mindful of budgets and the need for the medical institution to be profitable. It seems as if these issues comprise a three-part template for nursing: respect for patient value & individuality, education of patients, and cognition and respect for the realities of contemporary medicine. When there are issues surrounding unethical behavior, the standard view is that the issue is one of ignorance (unaware of the issue or policy), failure (sloppy medical work), or intent (purposeful negativity). Instead, Christopher Meyers (2004) believes that it is more the culture of the institution that frames ethical behavior than it is anything more purposeful. Indeed, in some ways Meyers' views take on a social-psychology role. Like Skinner's condition model, he believes that "culture plays a powerful and sometimes detrimental role in establishing the nature of the ethical debate…. Which is the organization's genuine mission, and what behaviors will be rewarded or criticized."

This view is echoed by Gaudine, et.al. (2011) in that medical staff may experience ethical conflicts when there are differing views between their own values and the values of the organization. Thematically, there are five major ethical conflicts within organizations that vary over the geographical spread of the research. Within each of these conflicts, however, the major theme echoes Myers -- different institutions, like different organizations, set the corporate culture of that organization. This might be due to a religious affiliation or sponsorship, the political or cultural orientation of the community or Board, or even the predominant viewpoint of the majority of the physicians who allow the flow of culture into their practice and with staff. Thus, the nurses' focus to be an advocate in that they will encourage, advocate, and enable the patient to take on part of the responsibility for their own care. This is not always a black and white issue -- for instance, sometimes medications can be painful and have uncomfortable side effects, which in the long-term, may have beneficial effects, but in the short-term may seem potentially harmful -- again, a utilitarian concept. However, while the nursing code of ethics echoes the Hippocratic Oath of "do no harm," the greater or long-term benefit to the patient may, at times, override brief discomfort in order to heal.

These five broad conflicts can be understood better if one looks at the thematic relationship they have to staff and/or the institution in question.

1. Lack of respect for professionals -- In particular in some of the larger HMO and Corporate Hospitals, medical professionals do not feel valued, but only "producers." Their salary, promotion and even quality of work are dependent on towing the administrative line in a profit and loss manner -- sometimes at the cost of patient care.

2. Insufficient resources for adequate patient care -- This issue is particularly relevant for modern nursing. While nurses are expected to take a more active role in patient care, there are serious staffing shortages that cause care to be mediocre through no fault of the individual nurse -- there are only so many things one person can do within a given shift. Nurses are the front line, but in struggling to meet the demand of the patients, ethical lapses sometimes occur due to understaffing.

3. Disagreement with organizational policies -- For most medical professionals, advocacy and the ethics of patient information…