Abstract
Different Ethical issues encountered in daily nursing practice draw little consideration but can produce a stressful working environment for the nurses. This qualitative study was designed to explore the ethical issues confronted by nurses in their practice and to identify gaps using the Pakistan Nursing Council’s (PNC) Ethical code framework. The study was conducted in six government hospitals of district Layyah, Pakistan. In all six focal group discussions (FGDs) with 6-8 participants in each were conducted. Content analysis identified three themes, namely; compromised professional accountability to patient, uncooperative behaviour of peers and poor image of a nurse in society. Nurses reported that they were unable to act on the PNC code fully because of many constraints in clinical practice. The reasons identified by the respondents were conflict in hospital admission procedures of patients, non-availability of medicines, conflict in informed and voluntary consent, false accusations by patients, care imbalance, compromised nursing care, and deficiency in amenities, patient’s expectations and cultural barriers. In addition, poor teamwork, inequitable workload, and poor value of nursing profession added to the challenges at the workplace. To our knowledge, this is the first study that has specifically addressed ethical issues in the nursing practice of graduate nurses in District Layyah. Nurses were aware about their ethical responsibilities but were unable to practice them because of the multiple constraints. The findings of this study cannot be generalized to other nurses in Pakistan, but the richness of the data suggests explanations for the difficulties which many nurses face in public sector health facilities while performing their duties and adhering to ethical principles in clinical practice.
Highlights
An ethical issue can arise in any healthcare situation where profound moral questions of “right” or “wrong” underlie professional decision-making and the care of patients [1,2]
The findings of this study cannot be generalized to other nurses in Pakistan, but the richness of the data suggests explanations for the difficulties which many nurses face in public sector health facilities while performing their duties and adhering to ethical principles in clinical practice
The inadequate equipment and instruments, shortage of staff, stereotypes of the nursing profession, poor management and poor support to address the issues resulted in distress, poor professional care, stress, conflict, compromised nursing care and violation of the Pakistan Nursing Council (PNC) code
Summary
An ethical issue can arise in any healthcare situation where profound moral questions of “right” or “wrong” underlie professional decision-making and the care of patients [1,2]. The current study was undertaken to identify adherence of nurses to the Pakistan Code of Professional Ethics, with an aim to improve patient care It explores the ethical issues faced by nurses in their clinical setting and how they work through difficult cases. The study draws on thematic areas that are intrinsic to any clinical encounter, namely: Medical Indications, Patient Preferences, Quality of Life, Contextual Features, Teamwork and value of nursing profession. These issues were reviewed in light of the professional ethical code prescribed by the Pakistan Nursing Council, inclusive of professional accountability with reference to the clients, colleagues and one self
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