Medicine is one of the most important areas of society because it predetermines its well-being. Health care involves many different tasks and professionals, one of which is nurses. These professionals have one of the most difficult jobs, complicated by working conditions. They are characterized by a difficult moral choices, increased workload and emotional burnout. It is necessary to analyze what exactly is the cause of the moral difficulties of nurses at work.
The list of functions and responsibilities of nurses working in adult or pediatric severe somatic and palliative medicine is extremely wide. Due to the proximity, intensity and duration of their contact with the wards and their families, nursing functions cannot be limited or reduced only to medical care for patients (Macintosh, 2021). They are inevitably associated with the provision of spiritual, psychological, and sometimes even psychotherapeutic support by nurses to their wards and their loved ones. In addition, people have different needs and are often in a difficult physical and psychological state (Butts & Rich, 2019). All this greatly increases the psychological and “moral” burden in the work of nurses (Butts & Rich, 2019). The most “energy-intensive”, taking away a lot of physical and psychological resources at the same time, are the following functions:
- Careful care for the wards, the desire to maintain a high quality of their life;
- Careful assessment of the condition of patients and their needs;
- Timely and accurate pain management, as well as assessment and non-pharmacological management of pain experiences in addition to drug analgesia (Butts & Rich, 2019);
- Emotional support for patients and families in times of crisis and when they need to be told bad news (Butts & Rich, 2019);
- Sharing with patients and families emotional stress, and difficult experiences, maintaining hope in them and preserving the meaning of life in a situation of serious illness and dying.
Nurses have to deal with the suffering of patients and their loved ones, with the death of patients, while they understand that the possibilities of their professional help are not unlimited. They feel the low social significance of their work and their position, which is further exacerbated by low wages and frequent depreciation of their work by other medical professionals (Macintosh, 2021). At the same time, the level of requirements for the performance of their professional duties is high. All this significantly reduces the motivation of the nurses (Butts & Rich, 2019). When working with children and adolescents, their emotional stress is especially enhanced due to the feeling of injustice, senselessness, and cruelty of what is happening.
Such psychological difficulties largely determine nurses’ low emotional satisfaction with their work, high moral distress and internal tension both at the emotional and cognitive levels. Their personal experience of unpleasant events, a collision with situations of illness and death in their own lives or the lives of loved ones in the past, when situations are repeated or similar in work with patients, can lead to the so-called secondary traumatization. Traumatization is facilitated by situations where sudden deaths or a series of deaths occur in departments and services where nurses work (Macintosh, 2021). Taken together, these factors can lead to psychological burnout of the medical personnel of palliative services.
This is generally defined as a loss of motivation to work, the mechanistic and formal nature of its implementation, and an abundance of psychological and somatic symptoms of a specialist’s trouble (Macintosh, 2021). Emotional burnout causes staff turnover, and a decrease in the quality of care and the level of care for patients in palliative care (Macintosh, 2021). Recently, the phenomenon of emotional burnout has been tried to be considered more closely, to differentiate and highlight aspects in it that can be targeted and effectively influenced.
The clearest observation of the ethical complexities of the work of a nurse can be directly in the example. According to the information provided, the nurse is faced with the choice of taking the patient’s life or saving it. This situation cannot be assessed unequivocally, so it is worth examining it from several angles (Appel, 2022). First of all, the patient is already 92 years old, and he is unconscious almost all the time (Appel, 2022). In other cases, he is not able to realize where he is and what is happening. This leads to the fact that the individual is not fully aware of his own life. In other words, he does not live, but survives, and is in pain. Moral principles attribute to the saving and preservation of the patient’s life, but in this case, it cannot be argued that he does not want to die (Vaughn, 2013). On the contrary, judging by the symptoms, he has already lost his ability and thinking, which means that he cannot make a decision (Appel, 2022). In such cases, the nurse should listen to the family, which by default is interested in alleviating the father’s suffering.
It is important to note that the sister may feel emotional attachment and compassion for the patient. This factor significantly complicates the case, since it is difficult for a specialist to make an unambiguous decision. However, here the nurse must turn to the definition of life to realize that Cornelius does not have the criteria of a patient who can be saved and returned to a normal existence. Nevertheless, it is worth analyzing an alternative point of view.
On the other hand, taking a patient’s life in this context can be interpreted as an unethical decision. The fact is that the family is not guided by concern for the father or regret, but by material gain. Because the children are afraid of not getting enough inheritance, they instruct them to turn off the patient (Appel, 2022). The nurse needs to take this aspect into account, since securing the death of a patient for financial gain is not an ethical decision (Appel, 2022). Accordingly, the nurse should not turn off Cornelius based on such desires of the family. However, the patient is in a serious condition that requires maintenance resources and will not lead to positive results.
Based on all of the above, the nurse still needs to turn off Cornelius and ensure his death. This would be by the principles of humanity since the suffering of the patient would end in this way. In addition, the family will be satisfied with the decision, since it is their conscious choice. Even though the children have a material interest as a reason for turning off Cornelius, they mention that the father himself would have wanted it (Appel, 2022). If they cheat, the nurse will not be at fault, which means she can make such a decision (Vaughn, 2013). In other words, shutting down Cornelius has more advantages than disadvantages for the nurse, the family, and the hospital.
In conclusion, it should be noted once again that the profession of a nurse is one of the most difficult. This is explained by the fact that specialists often face a difficult moral choice, which leads to burnout and the emergence of mental instability of a professional. In addition, often the working conditions are harsh, which negatively affects the nurse in various aspects. In the example of the case of Cornelius, it can be concluded that a specialist is under pressure from third parties, moral principles and ethical standards.
References
Appel, J. M. (2022). Ethics consult: Stop life support for a tax break? Medpage Today. Web.
Butts, J. B. & Rich, K. L. (2019). Nursing ethics. Across the curriculum and into practice. Jones & Bartlett Learning.
Macintosh, C. (2021). American nurse quits ‘profit-driven’ US system for a life in NZ. Stuff. Web.
Vaughn, L. (2013). Bioethics. Principles, issues, and cases. Oxford University Press USA.