Ethical Issues Faced by Nurses during Nursing Practice in District Layyah, Pakistan

Abstract

Key Points: Health professionals face ethical challenges in their daily practice, especially the nurses, the largest workforce in health. They are required to provide autonomous and collaborative care to individuals of all ages, while adhering to the ethical principles. The situation becomes particularly complex for nurses who work under severe resource constraints. Ethical issues in the nursing practice attract little attention, resulting in the creation of moral distress, poor professional care, unproductivity and conflict. This study has described ethical issues encountered by Pakistani nurses of one district under three themes: compromised professional accountability to patient, uncooperative behaviour of peers and poor image of a nurse in society. Nurses despite being well aware of the ethical codes, were not able to practice it fully because of constraints. The findings showed that nurses were not the decision makers in many situations; they were subordinates in their working environment. 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 PNC code. 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. 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.