Mónica Blasco-León,1 Silvia Rubí Ortiz-Luis1
1Hospital de Especialidades 14, Centro Médico Nacional Adolfo Ruiz Cortines, Instituto Mexicano del Seguro Social, Veracruz, México
Correspondence: Silvia Rubí Ortiz-Luis
Received: April 22th 2014
Judged: October 27th 2014
Accepted: November 17th 2014
In nursing ethics is a guide to making appropriate decisions with the aim of providing care that goes over facts to values and duties. In professional nursing practice, the application of these moral standards has been a marked deficiency. That is why in this essay a reflective analysis of the ethical and humanistic formation in different contexts is made: from the family, social, educational and institutional or occupational origin. All that, with the firm intention of retaking the course in our professional act.
Keywords: Ethics; Virtues; Bioethics; Morale
Nursing is a morally responsible profession. Historically, it has been characterized as a profession with a humanistic sense, setting it apart from other professions, including medicine. In the training curriculum, nursing is considered the lynchpin of humanist ethics in the health care of people.
However, in practice there are complaints from users when the nurse does not assume the function of defense, defined as action taken by a defender to represent the cause of another.1 Nursing practice involves a relationship between the nurse and the patient, which is necessary to promote, prevent, and restore health and alleviate suffering; the nurse should explain how they carry out that responsibility, so when this information is omitted, conflicts are created between patients and nurses, causing social ill-will.
This situation is worrying, since we nurses try harder and harder to reach better levels of professional training in order to improve our quality of services; however, it seems that there are factors that make our efforts unsuccessful and demerit our work or let it stagnate in sub-professionalization and middling quality of services.
Therefore, the purpose of this article is to reflect on the essential aspects related to the loss of ethics and values in the profession, in order to provide a series of reflections and questions on the context of professional nursing in Mexico and to somehow contribute to its development, progress, and professional prestige.
The word ethos (whose origin is Greek) can mean custom or character, and includes the behaviors that characterize a culture or a professional group. While it encompasses the use of certain values and a scale of values, it includes the common tradition and experience of a group, which are based on a hierarchy of values and in the directions of a profession or a social class.
Ethos can be defined as a set of values that a particular profession has and presents to society; it is the element by which this profession is recognized and worthy of confidence within society.
Therefore, the ethos is not fixed or stationary; it evolves with the profession and with environmental influences, so philosophical, religious, social, economic, political and legal influences are crucial for defining it.
The nursing profession has been shaping its own ethical profile throughout history and thus confirms the existence of three types of ethos that developed from the influences mentioned: the altruistic ethos, the agape ethos, and the philanthropic ethos.2
The altruistic ethos is at the origin of all the attention and care given by nurses from the time of primitive communities to ancient civilizations and the Greco-Roman world. Its main feature was friendship or love for human beings, for humanity.
Altruism was reflected in the forms of behavior that revealed compassion, respect, and honesty. The altruistic foundation is charity. According to this principle, doing good, not harm, caring for health, and promoting quality of life are the maxims of the charity ethos.
The agape ethos, on the other hand, was the ethos of nursing in early Christianity and the Middle Ages. Deacons and deaconesses after religious orders practiced nursing for everyone, moved by the figure of the Good Samaritan. They made their job a work of mercy and established equal conditions of treatment, and therapeutic and moral assessment of living with pain.
The philanthropic ethos of nursing emerged in modernity with the growing phenomenon of secularization and, consequently, of pluralism. Philanthropy again became the foundation of nursing and modernity’s expression of charity.
Therefore ethics, as a critical judgment of values, needs to meet certain conditions to influence the moral actions of people. Values are not just words; values without corresponding action are no more than a slogan, because values are why we live, the causes we stand for and fight for.
Values arise as a result of social and human coexistence. They are links that keep alive all structures of the social pyramid, from the family, the basis of society, to large organizations and countries. Thus every social group creates its own values which facilitate its development and progress, which results in environments characterized by respect for the rights, liberty, life, and even diversity.
Ethics intellectually analyzes the moral values of the people, i.e., their nature, their universality, and their diversity. Ethics is a characteristic feature of human beings; it involves cultural factors, history, traditions, education, and religious beliefs.
Nursing and other professions established their ethos through codes of ethics supported by the Geneva Convention, the Red Cross, the Universal Declaration of Human Rights, the International Labour Organization, and the Code of Ethics of the International Council of Nurses (ICN). This code was adopted by the Council of National Representatives (CNR) for the first time in 1953 in Brazil. The current code was adopted in 1973 in Mexico City and confirmed in 1987 by the CRN of New Zealand. This International Nursing Organization defines the ethos of nursing as the promotion and restoration of health, disease prevention, and relief of suffering.
ICN believes that the need for nursing care is universal and that respect for life, dignity, and human rights are essential conditions of nursing. Therefore, nursing makes no distinction based on considerations of any nationality, race, color, age, religion, political choice, or socio-economic condition.3
The most common ethical principles according to Fry4 are beneficence, autonomy, justice, fidelity, truthfulness, and confidentiality.
Nursing looms large within health services. Its importance lies in the health care of the individual and society, because of the moral qualities and virtues that it exercises, and due to the sacredness of human life it holds in its hands.
Nursing in our country evolved with the development of the historical and social context. Its origins date back to the colonial era with religious meaning and altruism. Only in the early twentieth century did professionalization begin and it took on a more modern and diverse profile, which was based in political, social, and economic changes in Mexico.
In recent decades ethics and deontology were established as training areas for nurses. Today the college graduate professional has the knowledge and the necessary information on the ethical and moral values related to patient attention and care.
However, in the workplace, it happens that the information and knowledge do not impact patient care, as it can be seen that ethics and values are missing, and our prestige and social recognition consequently fail to progress. It would seem that nurses are more concerned about professionalism or updating technology to cultivate the values of the care they provide.
In the reality of the hospital, patients ask the nurse to be sensitive to their pain. It is observed that the patient is identified by the bed number and, at shift change, the patient is checked so there are no outstanding tasks (language used to detect a patient’s need for something).
When caring for the patient, the nurse should demonstrate a feeling of empathy for them and pay them full attention. Sadly, at the end of the workday they do not know the patient’s name and argue that their workload does not allow nurse-patient interaction.
We ask ourselves: What is the essence of care? How is it provided? It would seem that ethics and values are missing and technology is bypassing us. However, one notices concern for aspiring to management positions with higher pay, which does give us the impression that professional training and the workplace are dissociated, since between the nurse and the patient there should always be a tie of fraternal and professional union, both in the suffering from the disease and the hope for greater wellbeing, with a relationship established between the nurse and the patient, so that links should be created to achieve the objectives, which, in this case, is the patient’s recovery of health and well-being.
The reality, however, shows a scenario of confrontation, where the patient claims their rights and the nurse eludes their professional responsibilities. Against this background, the question arises again: where must the action be directed? We must recover the profession sustained by ethical and humanistic values.
In general the morale of people follows coexistence and the social, political, and economic order of a people or a nation. Our behavior and our actions are the result of, and are regulated by, the rules that society dictates. From childhood we are all subjects learning values in all their dimensions, and based on these learnings we begin developing behavior governed and regulated by the evolution and by social norms established and adopted over time.
Cultural, social, political, religious, and various kinds of values are given in the various stages through which the human being passes. Ethics takes a prominent place in the professions; in some transversal and others vertical, all with the purpose of regulating and forming humanistic criteria in people’s decision-making.
Nursing has been characterized by its historical origins of religious, humanistic, altruistic, and selfless natures, symbolically attached to the policies adopted by the State and institutions. Professionalization at has all times adopted humanist models and has been based on values and principles of practice. In recent times the ethics and deontology of the profession have taken priority in the training of professionals. However, in reality professional standards and ethical principles do not apply in full.
Peplau (1952)5,6 describes and analyzes four phases in the nurse-patient relationship: (1) the orientation phase in which the patient seeks help as a result of their illness and can find alternatives for adaptation in their interaction with the nurse. In the identification phase (2), the patient thinks he knows what the situation can offer, and responds selectively to those who provide help. In the operational phase (3), the patient attempts in various ways to take advantage of the relationship and exploit existing goods and services available. As to the resolution stage (4), as soon as they meet the old needs completely, the patient gradually postpones them.
By analyzing the origin of nursing professionals from the social context, we can say that we are people who come from a lower middle social status, from large families, with the problems of our economic status and with public educational backgrounds. We can say that we often study nursing for lack of other options and opportunities, and because the field of nursing can be reached with technical-level education. From this picture, we can deduce that the professional tapestry that we see in health institutions is diverse in origin and training, bringing a number of both personal and social values of its own, and that these values are probably inimical to those established as institutional rules and taught as recipes applicable to the letter.
Another important factor is the birth of educational institutions that create curriculum with deficiencies in materials and academics, consequences seen in the finished products.
In the labor market, our profession needs reflection and the application of autonomy, which gives academic support acquired both in training and in daily practice: the experience7 considers that values are all that can give meaning to human life, producing esteem or admiration, so the main source to acquire values is the environment in which we live, in this case our work. We have such a great opportunity to interact with the individual, the family, and the community in permitted settings so intimate that they enrich us, increasing and fortifying our care actions. Not to forget, we name the 15 bioethical principles that UNESCO published in 2008:
Professional deficiencies of an ethical and moral character are observed that obey a social, political, and cultural history of nurses and all the circumstances involved in their training. Our performance is in no way detached from the historical social context that we have in our country; however, it is for us to correct all those details with educational training projects, which should be selective of both the institutions and the persons involved in the selection of human resources and nurses. Ethics and bioethics subjects must continue in the curriculum in schools and nursing schools, promoting the values between the student and the teacher, looking for all applicants to have a vocational profile to be nurses, taking the moral phenomenon that the profession crosses as a reflection and analysis during practice (as well as language and the moral foundations of providing care), taking up the ethical judgment made by nurses, as nursing ethics also includes ethical and bioethical issues from the perspective of the theory and practice of nursing.
It is understood that health and disease is an ongoing process of life. This leads us to plan and carry out a series of actions and interventions based on the needs of the individual; recognizing, respecting, and defending the moral conscience of patients makes each act of the nurse into a unique and transcendent act, because remember that caring is a relationship of and between people. The nurse must stop for a moment in their daily tasks and think about how it is not possible to care without a relationship, and that this establishes a bond of sharing and caring, every time the nurse and the patient are together, establishing an interpersonal nurse-patient relationship, based on the principle of listening to the patient in order to identify appropriate actions for the nurse to recognize the strengths of the patient and family; their understanding of the pathophysiological changes suffered by the patient and their sensitivity to the emotional, psychological, and intellectual subject's response to the disease. This consideration gives us the idea of understanding what the person does, thinks, and feels about themselves, disease, the environment surrounding them etc., that is, to recognize and understand their life systems and resources.6
It is hoped that the nursing profession will recover with time, when we link together efforts towards creating a decent and fair professional world, when we are able to spread awareness of our presence as essential to society.