How to Avoid and Prevent Coercion in Nursing Homes, Essay Example

Introduction

Ethical dilemmas are common in nursing practice because there are significant challenges associated with balancing the needs of patients with those of the profession. These are complex circumstances that influence how decisions are made and determine what steps are required to ensure that patients receive the best possible care and treatment at all times. One ethical dilemma that may occur in some settings involving older adults or those persons with limited mental capacity is coercion, whereby patients are not given the respect that they deserve and are coerced into specific behaviors to suit nurses’ needs, such as the use of restraints to control patients and hiding medications such as sedatives in foods (Gjerberg, Hem, Forde, & Pedersen, 2013). These dilemmas may occur when nurses are overworked and experience high levels of stress as a result of the difficult climate of the nursing home; therefore, they may believe that their actions are justified and are allowable in order to prevent further stress on a given shift. However, this is a serious ethical infarction that requires further investigation and should not be permitted as an acceptable form of behavior by any nurse within the profession. The following discussion will address acts of coercion by nurses in greater detail and will emphasize the importance of understanding the factors that influence decision-making by nurses for patients in a highly vulnerable state who may not possess the mental capacity to make decisions freely on their own.

Body

Coercive actions conducted by nurses are comprised of the following: “Types of coercion vary from the most obvious ones, such as different kinds of physical restraints, for example, bedrails or belts to protect patients from falling out of bed, to more hidden or indirect forms of coercion, such as covert medication in the patients’ food or beverages” (Gjerberg et.al, 2013, p. 632). These types of activities do not demonstrate behaviors that align with the morals and ethics of the nursing profession; therefore, they pose a threat to the overall development of nurses and their standing within the capacity of the healthcare system (Gjerberg et.al, 2013). These actions reflect a need to further examine the actions of nurses and what drives these types of behaviors, particularly in environments such as nursing homes or mental health facilities, as these actions pose a number of negative consequences for patients and for the profession as a whole. Nurses are responsible for optimizing the conditions under which patients are able to receive high quality care and treatment on a continuous basis. However, this is not always the case in these facilities, whereby patients face significant risks that are difficult to overcome and which create new challenges in advancing their needs in an objective manner.

Nurses who make decisions that involve coercion towards patients also demonstrate a lack of respect for the nursing profession as a whole, as it is a nurse’s responsibility to treat all patients carefully and under the duties, regulations, and ethical principles of the profession. These considerations have been in existence for many decades because nurses are responsible for providing their patients with the best possible conditions under which to thrive and to manage their health effectively. If this is not the case, these decisions must be called into question and should be evaluated for their ethical nature and value. For patients with dementia, for example, it is necessary to evaluate the conditions under which these patients struggle with their health, particularly as their mental status continues to decline; therefore, it is not uncommon for some patients within this group to be restrained for their own safety (Lejman, Westerbotn, Poder, & Wadensten, 2013). This reflects the importance of addressing the challenges related to restraints as they pose a negative impact on patients and their freedom, specifically when nurses contribute to these behaviors and restrain patients when this option is unnecessary (Lejman et.al, 2013). There must be a greater emphasis on understanding the nature of these behaviors and to determine how nurses should exercise greater ethical responsibility in these situations in order to support their patients in an ethical manner to prevent further risk and harm from taking place (Lejman et.al, 2013).

Nurses who work with patients who possess mental challenges may believe that these patients require coercive behaviors in some cases, such as the use of restraints (Hem, Molewijk, & Pedersen, 2014). Under these conditions, they may believe that it is ethically appropriate to restrain patients against their will because they believe that there are no other alternatives that are available (Hem et.al, 2014). However, this is not always the case and requires further consideration and an emphasis on creating situations that prevent coercive behaviors and which reflect positive and ethically responsible decision making by nurses in regards to the wellbeing of their patients (Hem et.al, 2014). This process also reflects the importance of understanding the decisions that nurses make and how they impact patient care in different ways, particularly as nurses are responsible for carrying out ethically appropriate decisions at all times.

Nurses face critical challenges related to their profession on a regular basis, some of which may pose a threat to their decision-making abilities. This requires an examination of the key factors that impact patient health and wellbeing and which reflect the importance of ethics in supporting all patients, and in particular, those who experience the highest level of vulnerability. Nurses who struggle with their decisions face difficult dilemmas that must be addressed so that they do not impact the care and treatment of their patients in a negative manner (Wolf, 2012). The risks associated with the profession are difficult to manage; however, they should not in any way compromise the health and wellbeing of the patients who require care and treatment at a high level (Wolf, 2012). For those patients who do not have a voice of their own, it is very important not to compromise their health through coercion or any other type of behavior that could ultimately cause further harm.

This ethical dilemma raises a number of questions regarding the ability of nurses to protect patient safety at all times and to enable patients to be protected from unnecessary risk or harm when they are incapacitated and cannot make decisions on their own. Nurses must be responsible for their decisions and conduct their behaviors in the best interests of their patients, while also considering other factors that influence how decisions are made that impact patient health in different ways. There must be an expanded emphasis on the development of new factors that will emphasize the importance of nurse-led decision-making and their protection of patients to minimize risks and support environments where safety is of critical importance. Nurses must also collaborate more effectively in order to prevent further complications for these patients, particularly when they lack a voice of their own and rely on nurses to make positive decisions on their behalf.

From a personal perspective, coercion in the nursing profession is a violation of the beliefs and ethical foundations upon which the profession was built. This reflects a lack of sound and reasonable judgment for patients and does not support the need for nurses to make positive decisions that are in the best interests of their patients. These factors reflect the importance of creating a caring and nurturing environment within nursing practice that is reflective of the core values and beliefs of all nurses. It is important to promote a healthcare environment and a society in which there are significant opportunities for nurses to play a critical role in shaping the healthcare system and the quality of care that patients receive. Nurses must serve as a symbol of excellence and hope in the healthcare system and should not compromise their principles with decisions that could ultimately threaten the lives of their patients in different ways. This is an important reminder of the need to remain grounded within the nursing profession and to exercise sound and reasonable judgment at all times in order to protect patients from risks that could otherwise be prevented. This process is ongoing and represents an opportunity to convey the importance of nursing-based decision-making that reflects the primary morals and objectives of the profession, particularly as patients receive treatment under conditions where they do not possess full mental capacity.

Conclusion

Ethical dilemmas within the nursing profession pose serious and challenging questions regarding the ability of nurses to make effective moral decisions on behalf of their patients that also align with the objectives of the field. This is a difficult issue to consider because it poses questions regarding the behavior of some nurses in the context of their ability to make decisions on behalf of patients, particularly when these decisions pose a threat to their health and wellbeing. Coercive behavior by nurses towards patients from vulnerable population groups is difficult to accept because it poses serious risks for patients and does not support the need and desire for positive health outcomes. When nurses compromise the care and treatment of their patients with coercive behaviors, this creates a serious ethical dilemma that leads to consequences for nurses and the profession as a whole. It is necessary to evaluate these issues and to optimize the conditions under which nurses are responsible for making ethically responsible choices within the nursing profession and to protect their patients from unnecessary risk or harm at all times. These objectives must serve as the hallmarks of professional nursing and support nurses’ ability to make profound and ethically appropriate decisions that will contribute to positive outcomes for all patients and optimize the core values of the nursing profession.

References

Gjerberg, E., Hem, M. H., Førde, R., & Pedersen, R. (2013). How to avoid and prevent coercion in nursing homes: A qualitative study. Nursing ethics, 0969733012473012.

Hem, M. H., Molewijk, B., & Pedersen, R. (2014). Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care. BMC medical ethics, 15(1), 82.

Lejman, E., Westerbotn, M., Pöder, U., & Wadensten, B. (2013). The ethics of coercive treatment of people with dementia. Nursing ethics, 0969733012463721.

Wolf, Z. R. (2012). Nursing practice breakdowns: good and bad nursing. Medsurg Nursing, 21(1), 16.