When nurses act as an expert, an ethical issue can develop because a paternalistic approach infringes on the patient’s right to autonomy. It is important for the nurse to assess the patient’s needs and promote patient participation in their plan of care. Although nurses are health care professionals and believe that they know what is best for each patient, the patient has the right to choose an unsafe course of action (CNO, 2009).
A specific example of relational inquiry practice that can counterbalance an expert professional view is using conversations about preferences. The nurse can assist the patient and their family to practice autonomy by assessing their preferences and help them to explore possible solutions and subsequent consequences to choices. This enables the patient and family to discuss and choose among possibilities without necessarily relying on advice from the nurse about which might be viewed as the best solution (Tapp, 2000). An ethical dilemma can be avoided by acknowledging and implementing the client’s choice as long as their choice does not compromise their well-being (CNO, 2009).
It is better for a nurse to act as a partner, rather than an expert in care because then the patient can build trust by being sufficiently included in decisions. The patient and the family is the expert of their own life because they know their own body and living environment best, and they are the key source of information necessary to initiate an appropriate patient-centred plan. Conversing about preferences with patients allows efficient problem solving and replaces a view of them as passive receivers of orders from medical professionals in their expert roles (Blomqvist, Theander, Mowide, & Larsson, 2010). Through inquiring relationally about the client’s preferences, the nurse can apply choices that stem from the patient’s experience of preferred outcomes in the past.
References:
Blomqvist, K, Theander, E., Mowide, I., & Larsson, V. (2010). What happens when you involve patients as experts? a participatory action research project at a renal failure unit. Nursing Inquiry 17 (4), 317–323
College of Nurses of Ontario (CNO) (2009). Practice standard: Ethics. Retrieved April 6, 2015 from https://www.cno.org/Global/docs/prac/41034_Ethics.pdf
Tapp, D. M. (2000). The ethics of relational stance in family nursing: Resisting the view of “nurse as expert”. Journal of Family Nursing 6 (1), 66-91
When nurses act as experts, nursing goals and values conflict with those of the family by assuming professional values align with those of the family. The goal of the nurse is use their knowledge, skills and judgment to provide care to families and individuals seeking the best possible solution to a problem through implementing interventions and evaluating their outcomes. According to Tapps(2000), “professionals may be at risk of pathologizing when it is expected that the concerns of those seeking assistance will necessarily fit the ways that we, as nurses, try to explain our understanding of the family’s concern using the language of our concepts, theories, and jargon”. In other words, when nurse act as experts, we tend to find or focus on a problem even if one does not exist creating a clash of values (Epstein, 2015).
In the case of Alex family, the nurses felt they were unable identify the family’s needs because they were focusing on nursing goals (problem solving) rather than the families goal of transitioning through illness. Doane & Varcoe (2015), suggest using ethical inquiry to guide the direction of nursing action by “being more intentional in your practice based on an analysis of your values in relation to the values of the people and families with whom you work and the values operating within the context of practice” (p. 263). Commendation can be used to counterbalance expert professional views by “highlight (ing) family strengths in a manner that is not problem focused but rather engaging and empowering” (McElheran& Harper-Jaques, 1994). The use of commendation statements acknowledge the skills of the family by being aware of themselves and illness thus able to identify their needs and goals as it relates to their healthcare needs while allowing for nurses to act ethically by promoting the wellbeing of the client as well as maintaining commitments to nursing practice.
REFERENCES:
College of Nurses of Ontario (CNO) (2009). Practice standard: Ethics. Retrieved April 6, 2015 from https://www.cno.org/Global/docs/prac/41034_Ethics.pdf
Doane, G. & Varcoe, C. (2015). How to nurse: relational inquiry with individuals and families in changing health and health care contexts. Philadelphia, PA: Lippincott Williams & Wilkins. (p. 262-263)
McElheran, N. G,&Harper-Jaques, S. R. (1994). Commendations:Aresource intervention for clinical practice. Clinical Nurse Specialist, 8, 7-10.
Tapp, D. M. (2000). The ethics of relational stance in family nursing: Resisting the view of “nurse as expert”. Journal of Family Nursing 6 (1), 66-91
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