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Role of nurse in advance technology and ethical dilemmas:-

Introduction:-
The recent unprecedented growth in technology has not been with out
cost to our society. In the health and human services field, the impact of science
and technology can be viewed in terms of informational technology as well as bio
medical technology.
Meaning of ethics:
Ethics derives from the greek word ethos! which means "customs#
habitual, usages, conduct and character.
$efinition of ethics:%
&' (aws of human conduct and duty
)' Ethics is the principles or standards governing proper conduct as applied
to professional problems
Technological advances in *ursing
&. Informational technology:
+s health care facilities continue to introduce, computes in to every phase
of operation, they take on numerous functions. These include
E,pansion of the role of allied health personnel to assist in mass
screening.
E,tension of medical services to under served areas via protocol
bearing
+ssistance in diagnosis and treatment of the patient.
Management of medical and nursing information.
Monitoring and controlling patient!s physiological systems.
-acilitating education for health care workers and patients.
.se of computers to assist in making clinical /udgments raises in fears
that health care providers will become overly dependent on them and lose
some of their intellectual capabilities to make such /udgment.
Technological milieu of today!s modern health care facility holds the
potential for patients and health care providers to interact more with
machines than with each other, thus reducing the degree of human
interaction, between patient and provider.
0atients can easily viewed as e,tensions of machines, and nurses may
spend more time ministering to patients machines than to the patients
themselves
1omputer decision guided solely by being seriously challenged as
governments, third%party payers, insurance companies and employers
gain access to computeri2ed medical record system.
)' 3io medical technology:%
The impact of advances biomedical technology has a profound effect on
health care services with the emergence of chemotherapy and computer medical
technology
+vailability of the life support systems, generic engineering, invitro fertili2ation,
se, selection, fetal surgery, and drug therapies to control emotions have raised
previously unpredicted social problems and changes in values and attitudes in
society.
4ome of the issues created by biomedical technology are:%
4hould we interrence in human conception and pregnancy through
artificial insemination, use of surrogate mothers, scloning or abortions.
4hould we screen potential parent for genetic defects and control their
reproduction if there is a danger they will produce an offspring that
could be a burden to society.
4hould we intervene with fetal surgery to preserve the life of a fetus at
a great finical cost to society.
Technology assessment and planning should take into account a
compled variety of philosophical, religious, economic, political, legal
demographic, environmental and behavioral factors.
Most of the /udgment about the use of biomedical technology have
been left up to the scientists who develop them and have been limited
to safety and efficacy.
+t best, their impact has been determined only with regard to specific
population the larger social 5uestions such as the cost benefit ratio and
appropriate utili2ation or sustification for the technology remain
unanswered.
The technological imperative if the technology is available, use it leads
us down a path of no return where we are unable to turn off the artificial
heart or remove the protective life island bubble because in the interests
of research and technological e,perimentation too much has been
invested in the patient to let him succumb to the incurable disease
process.
Impact of technology on nursing practice
The rise in medical technology in the past decades has enhanced the
status and power of medicine as the public began to believe medical
science could at least cure are ills.
Emphasis on the curative power of medicine has diminished the status of
the traditional role of the nurses as the care giver who had significant
impact on the 5uality of life of the incurably ill and dyaing patient.
*urses have often found themselves left out of the decision making
process and implementing physician decisions and facing their
conse5uences without having had any input into them.
More recently recognition of the essential components of care and
comfort as important ingredients of health care, has restore some degree
of nursing status an nursing involvement in patient care decisions.
Biomedical technology creates two categories of problems for nurses in
making clinical decisions.
&' The first problem is one of determining what is the best moral choice in
light of the gray boundary areas presented by biomedical technology.
)' The second problem is the increasing cost benefit ratio treatment choice
conflicts between health care institutions, physician, scientist and nurse
"care# gives.
In the area of determining the best moral choice in patient care decisions,
nurses are guided by the underlying morale principles.
&' The nursing code of ethics To prevent harm and to promote highest level
of health possible for their patient.
)' The international code for nurses! states that inherent in nursing is respect
for life, dignity and rights of patients.
6' In ethical language we can say that the ethical codes of nursing hold the
principles of sanctify of life beneficence 7doing good'
8' *on malfeasance 7avoiding harm' and autonomy 7self determination' to be
the overriding principles in guiding practice.
+lmost always when ethical conflicts arise in nursing practice as a
conse5uence of technology, they are caused by a conflict between up holding
one or of these principles verses upholding an opposing practice.
Role of nurse in advance technology
The nurses play an important role in advance technology utili2ation and
development. There are includes.
&' The nurses utili2ed the advance technology in patients nursing care.
)' *urses mange the patient!s medical and nursing information.
*urses used computer and other technology for patients diagnosis
*urses used modern technology for the patient care and monitor accurate
physiological functions of the patient.
.se of advanced technology help in decision making.
*urses using the research findings in develop the new technology in
nursing care.
*urse leader e,plain the uses of advance technology in patient care
*urses maintain the up to date knowledge regarding advance technology
9ith the help of technological advanced the nurses provided 5uality of
nursing care to the patient and evaluate the technological effectiveness in
patient
Ethical dilemmas in nursing
$efinition:%
It is defined as a situation re5uiring a choice between two e5ually
desirable or undesirable alternatives. *urses in all clinical and functional
specialties for the following ethical dilemmas.
&' *eed to ratio patient care to conserve scare resources
)' *eed to make treatment and care decisions for terminally ill patients.
6' *eed to obtain patients informed consent for care and treatment orders
and measured such as.
a' do not resuscitate order
b' 9ithholding : withdrawing nutrition and fluids.
8' ;esponse to patients re5uest for assisted suicide
<' *eed to balance the patients need for confidentiality and privacy against
society!s needs for protection from unreasonable risk.
.sually the dilemma occurs when opposing views are scan for the solution of
an issue and decision must be made. There is no set of procedures or easy
answers for how an ethical dilemma should be resolved. + nurse can best
resolve ethical dilemma, by systematically all options for solving the dilemma.
Example for ethical dilemmas and possible responses.
&' .nsafe nurse to patient ratio + pattern of unsafe nurse to patient ratio
can be caused by staffing problems, be they team porary or longer term
+ddress this unsafe situation verbally and in writing to the nurse unit.
1hange nurse with copies to the nursing supervisor and director of
nursing.
This will likely prompt action by the hospital such creating an as needed
pool of nurses to call for such situations, hiring more staff in the interim,
securing contracts with outside nursing agencies and utili2ing agency
nursing personal.
Ethical dilemmas in various epartments.
*ursing involves caring for all aspects of a persons health care needs, not
/ust care during a hospitali2ed illness.
Issues may arise in any of the following areas for which the nurse is accountable,
self profession, client and family, employing institutions and society.
!ommunity health "ursing
+s provides of primary care, community health nurse!s work with clients in
situations that are often very difficult from those faced by other health care
workers. 1lients and their families face difficult decision regarding diagnosis and
treatment ad the social implications of disease. The community nurse is
especially concerned with the social and environmental factors in health and
wellness.
#or example:
+ mother needs care for her &< year old daughter!s to assess the daughter
need to determine whether a health problem e,ists. 4he has the right to be
informed and referred to a physician if she uses birth control. +s an advocate she
ensures that the patient has sufficient information to make a decision.
$ome health nursing:-
1hanges in reimbursement have created the incentive for hospital to
discharge clients in a timely and effective manner. +s a result nurses in hospital
often have less time for educate or prepare clients and families for care needed
in the home more clients return home with pain, chronic illness and completely
healed wounds.
Issues:-
-or eg + patient with limited knowledge of self care may re5uire several
instructions sessions. The nurse has an ethical responsibility to give client the
information they need failure to give instruction could leave this client information
and at risk medical complication.
"ursing of children
The ethical 5uestion of whether a person should be allowed to die is one
of the most difficult faced by health care professional and society
Issues:%
The issue is more value, when if involves children of the child suffers from
a terminal illness or brain in/ury, parents and family members may have decide
between pursuing life at great cost and allowing this child to die. 4ome believe
that there is right to choose relief is dying
3ut some other they argued no individual has the right to determine when life is
over. The ethical principle of autonomy gives the parents to take decision. The
nurse helps the parents to clarify their own values and then support the decision.
"ursing $omes:-
There is an increase in number of older adults entering nursing homes are
victims of abuse from family members. The older adults e,perience physical and
psychological abuse, financial and personal e,ploitation. The nurse may see
symptoms of physical abuse, when a client first admitted to nursing home. +
ma/ority of other health care professionals to report the abuse of older decision.
Many abused older adults are to make their won decisions. The nurse should
make careful assessment with patient and family.
%ental $ealth "ursing:-
1onfinement in a institution is an e,ample of depriving person to freedom.
=owever, mental health care professional have variety, if less e,treme methods
to control behaviors in the interest of the persons health and welfare of society.
Tran5uili2ers, electric shock and psychosurgery are e,amples. Many ethical
issues arises "9ho is e,pert enough to identify normal behavior should the nurse
participate# "9ho desire whether the behavior is normal or abnormal#
Ethical problems in medical surgical nursing
>f all the treatment situations e,periences by medical surgical nurses
few raise as many ethical 5uestions as organ transplantation. 9ith the success
of organ transplants, ethical concerns have increased. The availability of donor
organ is limited, making transplants a scarce resource, what criteria should be
used to determine, who should be a recipient? 4hould a transplant be withheld, is
a client cannot afford if? *urses care for donors and recipients, and issue of
organ transplantation can become very emotional.
The option of organ donation raises many 5uestion will the body be
disfigured because or organ or tissue removed? +re there donor costs related to
organ recovery? 9ill burial be delayed? 7the answer to this entire 5uestion is
"no#' The nurse learns to be an advocate, giving families decide against
donation@ their right to make that decision should be respected and support.
*urse physician client relationship:%
In addition to clients, nurses are also accountable to families, health care
administrators and physicians. Ethical duties to all of these participants pose
uni5ue problems for nurse. These duties may conflict simultaneously.
-or eg +ssume that a nurse us caring for a client whose wife has died
during his hospitali2ation. The client asks fre5uent 5uestions about why his wife
has not visited. The client of his wife!s death for fear that an emotional setback
would worsen his condition. The nurse!s duties to the clients need conflict with
the duties to follow the physician!s order. The nurse!s responsibility to provide
psychological support has been made more difficult because the truth cannot
share with the client
"urse "urse&s relationship
In most areas of nursing practice nurses work together. 3ecause of
these interdependent relations one nurses practice affects by the practice of
others. 9hen one nurses acts unethically 5uestions may be raised about the
entire nursing team. 4everal factors add to the comple,ity of ethical issues
between nurses levels of e,perience among nurses very widely. ;egardless of
Educational preparation and e,perience nurses are e,pected to perform
competently ethical conflicts between nurses may arise when a nurses
competence is 5uestioned.
-or eg% a hospitali2ed client complains to the nurses working the evening
shift about on the day shift who was rude and slow to respond to calls . the client
doesn!t want the evening nurses to tell anyone about the incident for fear that
the day shift nurses will become angry. if the client report is true the off ending
nurse has failed to meet the obligation an ethic of care . .nless something is
done additional problems may develop between the day nurses and the client.
4henld the evening nurses report the incident?
Is a nurse has been observed by peers to make mistakes and becomes
rude with client. 4omething must be done about the nurse!s behavior. + nurse is
not demonstrating responsibility, accountability or care if the unethical conduct a
colleague is ignored. 1areful /udgment is needed to resolve the dilemma of
unethical professional relationship.
*ursing ;esearch:
*ursing research can contribute the body of knowledge influencing
nursing practice. ;esearch involving human sub/ects can be useful and
beneficial. The nurse is ethically responsible for obtaining free and informed
consent from persons participating in a complete study in timely. + client who
hurriedly signs consent from without asking 5uestions may not understand,
study!s purpose and implications. The nurse must be sure that all patient involved
are fully informed.
"urses Role in ethical ilemma.
The resolution of this dilemma is that nurses are more technicians who
implement third party decisions regardless of whether the decisions are
consistent with their personal : professional beliefs and code of ethics.
+ fre5uent source if ethical dilemma is the use of invasive technological
treatment to prolong life with patients with limited or no decision making
capacities.
*urses continue to be with comple, 5uality of life and treatment decisions
with incompetent patients.
9hat criteria should mental competency be determined? Is mental
competency a state all or hothing phenomena? Aust because a patents is
confused or depresses, some or most of the time does that mean he has
nothing to say in the decision making process? In there such a thing a
partial mental competency? Is an incompetent person a full human and
hence no accorded full human being or less than human and hence not
accorded full human rights, among them the right to make decisions and
the right to life?
4ince we traditionally accord right to life and right to treatment to human
beings only, how we define humanness or personhood.
$o we have the right to make a /udgment about the 5uality of some one
else!s life?
=ow do we determine the criteria by which human the 5uality of life for
another human being? My idea of the good life may not be the same as
those closes to me much less the same as my patient.
These are but a few of the very serous ethical dilemmas facing nurses in
technological health system that at times presents seemingly unlimited
choices in determining who shall live and who shall be permitted to die
9hat do nurses@ do about their duties as professionals and rights as
individuals with certain value system?
If patient have a right to die does the nurse have the duty at all times to
see that patients have that right met?
If you allow patient to die by allowing them to refuse treatment, you are
respecting their autonomy and self determination you avoid dehumani2ing
them by paternalistic practices that may prolong life. 3ut are you
recogni2ing and preserving the patient!s autonomy by doing so? 3y
refusing treatment the patient dies 5uicker.
4ome would argue that once you are dies you have no more autonomy or
freedom to make or act on you own decisions because you no longer
e,ist.
*urses as health care providers continually hear that patients want to die
a dignified death. 9hat really is death with dignity? 1an death ever really
be dignified?
Ethical decisions are social decisions because they take place in a highly
comple, social environment consisting of different health team members
who may have widely different value systems.
'(%%)R*:
4o far we have discussed about informational technology, biomedical
technology, impact on technology in nursing practice, role of nurse in advance
technology and ethical dilemmas and nurses role in ethical dilemmas.
Bibliography:
&' $elong, mclocksey "Issues of trend in *ursing# )
nd
edition, mosby
publication page *o 66B.
)' Ci/ay. 3. 7)DD)'7 "*urses $ilemma ethical issues, the nursing /ournal of
India, page *o% EF EB.
6' 1atherine and schmidf "=ome health care agency *ursing administration#
Col )D, 0age *o &G &B.