Pressure Ulcers Elimination: Ethical Issues

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Table of Contents

Ethical Theories Evaluation
Ethical and Cultural Perspectives of Inquiry
Inquiry Details
Ethical Perspective: Theories for Application
Cultural Perspective: Cultural Norms and Values
Conclusion
References

Ethical Theories Evaluation

The chosen topic area is the elimination of pressure ulcers among patients in the emergency department. A protocol should be developed to remove associated complications for patients and the medical staff. To complete this task properly, certain ethical theories must be evaluated.

Ethical Theory	Rank (1=most important, 5=least important)	Reasons
EGOISM	1 2 3 4 5	Principles of patients matter. This theory can work until the ethical rights of one person do not interfere with the ethical rights of another person (Shayan, Ahmadinia, & Hassanian, 2017). It is chosen because of the self-interest principles in nursing.
UTILITARIANISM	1 2 3 4 5	Utilitarianism is focused on the outcomes, but not on a process. This theory allows breaking the rules in case positive results can be achieved (Welsh, 2014). Pressure ulcers have various outcomes, and nurses should be ready to act fast.
DEONTOLOGY	1 2 3 4 5	Deontology underlines the importance of right actions and decisions. There is a list of rules that have to be applied in all situations (Welsh, 2014). This theory is chosen to underline the importance of rules and protocols in pressure ulcer interventions.
CARE ETHICS	1 2 3 4 5	Care ethics develop a background for the creation of an intervention. Compared to other theories where cognition and deduction matter, it uses emotions and sensitivity as the source of knowledge (van Dijke, van Nistelroij, Bos, & Duyndam, 2018). This choice is explained by the presence of emotions and empathy in nursing.
VIRTUE ETHICS	1 2 3 4 5	Virtue ethics is a young approach to nursing. This target-oriented theory evaluates situations so that the right course of action can be achieved (OMadigan Gribble, 2017). This choice combines responsibilities, situations, and emotions.

Ethical and Cultural Perspectives of Inquiry

Pressure ulcers cause problems for patients, nurses, and other medical staff, and the inability to predict the outcomes of this physical condition makes people think about possible interventions. One of the options can be the development of a protocol according to which nurses should take care of dependent patients who are under threat of pressure ulcers development. The inquiry of this issue depends on many different factors. In this paper, ethical and cultural perspectives of the issue will be discussed, including the evaluation of the ethical theories that may be applied to the chosen intervention and the identification of the cultural values and norms that may have an impact on patients and nurses.

The following research questions will be answered in the paper:

What kind of intervention is appropriate for pressure ulcer prevention?
What ethical theories can be applied to the chosen intervention?
What cultural norms should be recognized in the discussion about pressure ulcers?

Inquiry Details

In the development of interventions to control pressure ulcers, nurses and other stakeholders should stay careful with definitions, theoretical backgrounds, past research, and practices. Swafford, Culpepper, and Dunn (2016) define pressure ulcers as any area of skin or underlying tissue that has been damaged by unrelieved pressure or pressure in combination with friction and shear (p. 153). This health issue is preventable, and it is recommended to consider the latest technologies and discoveries to understand what kind of help may be offered in hospital settings. Multifactorial prevention programs with special revised skin-care protocols as one of their integral parts were offered by Swafford et al. (2014).

The peculiar feature of this intervention is to focus on various patients details, including their age, race, the reason for immobility, the type of trauma, and the reactions to past treatment plans. Successful implementation of this idea can save human costs (healthcare spending) and lives (the decrease in patient harm) (Welsh, 2014). To achieve positive results, the consideration of ethical and cultural issues should not be neglected by nurses as the direct developers of protocols and patients as the main participants.

Ethical Perspective: Theories for Application

The application of theories in nursing practice is characterized by a number of concerns and discussions. On the one hand, nurses with all their professional integrity and knowledge should do the right things and make appropriate decisions by acting in accordance with their behavioral targets, respect, and compassion (OMadigan Gribble, 2017). On the other hand, nurses cannot neglect the role of empathy in their work that turns out to be a biased and inaccurate projection of their help (van Dijke et al., 2018). Both these aspects are the outcomes of the two strong ethical theories of virtue ethics and care ethics. They prove the necessity to apply theories to the chosen issue of pressure ulcer intervention.

Along with these theories, the implementation of protocols in nursing care can be improved with the help of other well-known approaches like egoism, utilitarianism, and deontology. When a theory is put into practice, the creation of an open and comfortable environment is possible along with the development of positive nurses and patients attitudes to care plans. However, some cases may be too complicated, and prevention can be impossible.

The process of applying ethical theories to the issue is clear. It is not enough to read the rules and follow them precisely. Nurses have to read each theory carefully to clarify what attitudes they are free to develop and when personal interpretations are allowed. For example, egoism theory in nurses underlines the necessity to follow personal interests or maximize the interests of patients to achieve certain benefits (Shayan et al., 2017). Utilitarianism theory is focused on the results of interventions, and morality and ethical appropriateness occur when positive outcomes are observed. This theory can be applied only when nurses are confident that their steps and decisions are appropriate.

The application of deontological theory is characterized by absolutism and a number of rules that cannot be broken. Some nurses can face certain challenges following this theory because they are not aware of how to organize their emotions or follow the same instructions under different conditions. Effective nursing care and the prevention of pressure ulcers can be possible if the best theoretical frameworks are introduced in the setting.

Cultural Perspective: Cultural Norms and Values

Pressure ulcers introduce a type of wound to be carefully treated as soon as they are diagnosed or even prevented when patients are in the conditions that may lead to such problems. As well as any other care offered by nurses in healthcare settings, wound management, and pressure ulcer prevention should be based on an understanding of cultural sensitivity and awareness of the existing cultural values and norms.

To be culturally aware of patients, nurses should not only use some facts about their families or attitudes to treatment but also provide patients with culturally relative information (Welsh, 2014). Pressure ulcers are characterized by pain and discomfort, and there are many cultures where the pain is defined as a normal part of life that should not be decreased or removed. Patients and their families can define pain medications as a threat to which addiction may be developed. Therefore, the drugs that can relieve pain or predict complications may be forbidden in some cultures.

The role of the family is a cultural value that can never be ignored. In many countries, gender inequalities considerably determine family relationships. Health information may be available to all members, and certain facts should be known to a patient only, proving the importance of the familiarity bias and the level of trust (van Dijke et al., 2018). Family traditions introduce the norms that can influence care processes.

In many modern countries, there are special days and holidays when no work or activities are allowed. The same expectations can touch the healing process or the date of surgery. Nurses have to learn at least several facts about patients cultures to avoid misunderstandings. Even such a minor detail as footwear can change the attitude to health care. People may support the idea of taking off their shoes each time they enter a room or, at least, have the shoes to change. Nurses are aware of these details and can support their patients in their intentions to be culturally appropriate, and some nurses neglect these issues in pressure ulcer prevention, causing new problems and challenges.

Conclusion

In general, pressure ulcer control and prediction are the tasks that many hospitals should try to achieve every day. Nurses as the direct developers of programs and protocols can observe the results and check if the reduction of negative outcomes is possible. The analysis of several past studies shows that multiple attempts were made to eliminate the problem of pressure ulcers in the patients in the emergency department. Several steps were successful, and some steps had to be improved.

However, despite a variety of outcomes, nursing care remains a serious aspect of health care. Nurses should know how to stay ethically correct in their care decisions as well as to learn patients traditions, cultural norms, and values. The role of all these aspects is integral for the chosen issue and the healing process for patients. Clinicians who are involved in pressure ulcer prevention can face a number of ethical dilemmas and standards. Personal and professional accountability and the possibility to ensure compliance with the theory and policy can improve the practice.

References

OMadigan Gribble, M. (2017). Environmental health virtue ethics. The American Journal of Bioethics, 17(9), 33-35. Web.

Shayan, A., Ahmadinia, H., & Hassanian, Z. M. (2017). Nurses perceptions of the ethical climate existing the educational and medical centers. Journal of Nursing and Midwifery Sciences, 4(2), 42-48.

Swafford, K., Culpepper, R., & Dunn, C. (2016). Use of a comprehensive program to reduce the incidence of hospital-acquired pressure ulcers in an intensive care unit. American Journal of Critical Care, 25(2), 152-155. Web.

van Dijke, J., van Nistelroij, I., Bos, P., & Duyndam, J. (2018). Care ethics: An ethics of empathy? Nursing Ethics, 1-10. Web.

Welsh, L. (2014). Ethical issues and accountability in pressure ulcer prevention. Nursing Standard, 29(8), 5663. Web.

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