In today’s society, there are many ethical dilemmas that nurses are faced with that are virtually impossible to solve. One of the most difficult and controversial issues that society is still facing is racism. Nursing as a profession seems to avoid considering the problem of racism (Vaughan, 1997). There is, however, a need to address this topic and to evaluate its implications for nursing practice. The ethics committee has to step in when an ethical dilemma arises and a decision must be made based on application of the universal ethical principles. Introduction
The health care sector of American society is far from immune to social injustice and the various forms of inequality that negatively impact other societal systems. The United States health care industry has been and continues to be plagued by racism. During the pre-Civil War, Reconstruction and Jim Crow eras of American history, overt racism within the medical sphere was common. After the Civil Rights Movement of the 1960s, segregation and some of the more blatant manifestations of racism dissipated. More subtle forms of racism, however, continue to pervade the health care industry.
Historically, the American Association of Colored Graduate Nurses united with the American Nurses Association (ANA) in 1952, before the general Civil Rights movement in the United States. There have always been prominent nurses of color, such as the past president of the ANA, Beverly Malone; the current president of the National League for Nursing, Rhetaugh Dumas; and the current president of Sigma Theta Tau, May Wykle. These women are all African-Americans who have been leaders for all nursing throughout their long and distinguished careers.
They are just three of the many ethnic/racial minority nurses who have made significant contributions to Nursing (Shaha, 1998). This is a real situation encountered on a post partum unit by a nurse supervisor. The situation describes an ethics consultation about the decision of a patient who refuses to be cared for by an African American nurse. The ethical dilemma is presented from the viewpoints of the patient, nurse, and ethics committee. The ethics committee steps in whenever an ethical dilemma arises and solves the problem based on universal ethical principles (Corley, 2002). History
Patient is a married 42-years old female, who has a PhD in health care and a history of two pregnancies. She is currently on a post partum unit after delivery of her second child. She had a C-section four hours ago and has just been admitted to the unit. Before the admission the nurse from Labor and Delivery heard the patient saying to her husband “I hope this time we do not get a black one”, as she was referring to the nurse who will take care of her in the post partum unit. By the time she was admitted there had been a shift change and the nurse supervisor handled the admission herself.
The patient verbalized that she had previously had a bad experience in the same hospital with an African American nurse who forgot to give her pain medicine after the C-section and she hopes that this time she will not be facing the same consequences: horrible pain that could not be controlled for two days. She asked the nurse to assign her the best nurse they have on the unit. The ethical dilemma arises when the nurse assigned to this patient for the day is an African American nurse. This nurse is also the best nurse on the floor with an extended experience of 20 years on post partum and is a very knowledgeable person.
She has a BSN and currently is working on her MSN in Obstetrics. All other nurses on the post partum floor on this day are floaters. After the nurse introduces herself to the patient, the patient asks the nurse supervisor to assign a different nurse. How is the nurse supervisor going to handle this? How is she going to explain that the African American nurse is the best nurse they have for that day without hurting the patient’s feelings and helping her to gain trust in the assigned nurse?
How is the nurse going to handle this patient knowing that she is judging her based on her race? Is she going to give her the same care afterward or the patient will suffer? Is the patient willing to accept the care from an African American nurse? Ethical Dilemma An ethical dilemma arises when the decision-maker experiences indecision because available choices or alternatives support conflicting values or ethical principles or rules support mutually inconsistent courses of action.
The most general ethical principle for human action is “do good–avoid causing evil“. Moral rules and ideals have to do with avoiding causing evil. Beneficence and utilitarian ideals have to do with doing good. Nurses use the principle of beneficence or nonmaleficence while providing care. Patients have the right to refuse care and medical treatment (mhcc. maryland. gov). This case is very sensitive because the patient refuse contact with one specific group of people, African Americans, but does not refuse care in general.
The charge nurse will use the veracity principle by telling the truth to the patient that the nurse assigned for the day is the best. The fairness principle is applied here too. The assigned nurse is fair to patient in order to provide good care. Confidentiality is maintained throughout the hospitalization. The nurse does not share patient’s information with anyoane beside the health care team. Equality is another ethical principle used here when making the decision of who is the best to provide care for the patient in order to benefit the patient and not hurt her feelings (www.nursingworld. org).
When ethical issues arise in the nursing field these ethical principles are guiding the health care professional in decision making. Clinical Evaluation and Ethical Issues When an ethical dilemma arises it needs to be brought to the ethical committee. The nurse assigned for the day called the ethical committee and brought up the patient’s and the charge nurse’s opinions. Since the patient had just been admitted to the floor, she needed to be assessed and have medication administered before the pain kicks in.
Since she is refusing care from the nurse assigned, her care is delayed. This might result in complications in the patient’s health condition. The nurse acts here as the patient avocate by protecting the patient’s right to self- determination. Nursing Management The nurse is acting as the patient advocate; she brought up the situation to the ethical committee saying that the patient will suffer if treament is delayed. Does the nurse know what to do in this situation? Can she handle this dilemma? The ethical committee met and looked at the facts.
Based on the principles of nonmaleficence, freedom, equality and justice they decide that the nure assigned for the patient is the best choice for her. Nursing intervention and Issues The nurse assigned to the patient started by assessing her thoroughly and then developed a plan of care. The patient received pain medications every 4 hours as needed and a pain assesment was done every hour. If a patient is experiencing moral distress, the nurse may confront the barrier, teach the patient how to take action or empower the patient to eliminate the barrier.
Summary Racial inequality is not unique to nursing. There are those who assert that America is indeed a racist society and that this racism is perpetuated by ignorance, apathy, poverty, and discrimination. Do not forget that racism, both active and passive, is not limited to relations among blacks and whites. Racism knows no bounds and can affect literally any subpopulation that occupies a “minority” status. Little or no research exists on race relations between other ethnic groups. The need for further research in this area is crucial.
To combat the problem of racism in nursing, whether perceived or real, nursing must first embrace diversity as an established mode of operation. Nursing faculty, in mentoring the future of the profession, should embody principles valuing diversity. It is only through accountability that we may implement and actualize diversity principles in order to ensure success of the profession into today’s nursing. Ethical discussion within training programs for nurses and the formation of units to deal with resolving ethical problems should be taken into consideration (Labunski, 2003).