Social justice as one of the ethical issues nurses experience

Social justice as one of the ethical issues nurses experience

Social justice is one of the ethical issues that nurses, particularly those at family and community level experience. Working as a women health’s care nurse practitioners (WHNP) in one of the marginalized community, I have had an experience of the impact of social injustice particularly among the expecting women and had to act to help the vulnerable mothers and their babies. In the state where I work, WHNPs operates with full autonomy which motivated me to create access opportunities and improve health outcomes of the expecting mothers. Often, these mothers cannot afford high-quality care nor access obstetrician or gynaecologists due to their low socioeconomic status, which is not their wish. These impacts their health and babies since most mothers wait for complications to resolve on their own. Expecting mothers were waiting until conditions are worse to seek care which improves their chances of complications and reduces quality pregnancy outcome while others gave birth at home, which increased their chances of infecting of their babies. A significant number of expecting mothers did not attend any prenatal care due to lack of knowledge, particularly the new mothers, inadequate resources include professionals, capital and facilities and some stated cultural beliefs as a barrier.

Nurses are often faced with ethical dilemmas which call for the moral principle of ethical decision making to help inform nurses’ actions and care. Nurse face is the dilemma between respect for autonomy and beneficence. While working in the emergency department, I came across a Jehovah’s Witness patient who came to the emergency room with massive chronic bleeding. He required a blood transfusion since he had lost a lot of blood, and the bleeding seemed not to cease based on my assessment. However, he refused the blood transfusion citing that his religion did not allow it. He was alert and very competent and was informed of the benefits of blood transfusion as well as the consequences of refusing the intervention. He thanked me for the information and insisted that he did not want blood transfusion and was ready to sign. His condition began to deteriorate, and his motor response was alerting. Here the medical team was torn between respecting his autonomy and obeying the beneficence principle to initiate blood transfusion to save his life.

Summary

The first situation depicts social injustice, and I had to exploit my legal and ethical responsibilities, and duties as a board-certified women health’s nurse practitioners to help the situation. Thanks to my optimistic view of the situation. I noticed these inequalities and had to make it an opportunity to improve care and provision. I organized a team comprising of four WHNP and six nurses who understood the situation and began to provide timely, safe and high-quality and affordable obstetric and gynecologic care to the vulnerable expecting and new mothers. We observed the nursing code of ethics and scope of practice for registered nurse and WHNP throughout our practices and care. I also led the team in the community outreach programs educating expecting and new mothers on healthy habits, practices and behaviors as well as how to take care of themselves. Besides, the team conducts home visits to enhance the outcomes of mothers and their babies in the community and ensure that mothers receive timely, safe and quality care as needed. We aimed to venture in prevention and empowerment, which has resulted in reduced cases and significantly improved mothers and babies’ health outcome.

The moral principle of autonomy provides that nurses respect the patient’s decision as long as the patient is alert and competent. The second situation depicts a conflict between autonomy and beneficence. The patient refused to have a blood transfusion even after knowing its benefits to his health and outcome and the consequences of refusing a blood transfusion. He had signed meaning that we had to respect and support his decision though we did not agree with it. I made sure the patient was comfortable all through and tried other intervention such as administering 20mg/kg of tranexamic acid within three hours followed by administration of iron supplements and dietary advice to replenish the lost fluids. The patient was monitored closely, and he finally recovered.