Knowledge And Practice Of Nursing Ethics Among Student Nurses In Central Hospital Sapele, Delta State

Knowledge And Practice Of Nursing Ethics Among Student Nurses In Central Hospital Sapele, Delta State

Abstract

This is a descriptive design survey on the knowledge and practice of nursing ethics among student nurses in central hospital Sapele, Delta State, Nigeria. The purpose of the study was to determine the nurses’ knowledge of ethical principles and how the principles are applied to the care of people with illness. The study also identified some perceived factors that do hinder the application of ethical principles to practice. The findings revealed that the nurses have high knowledge of ethical principles. On application to practice, it was revealed that the respondents do embrace ethical principles in the care of their patients except in the area of admitting and restraining of patient against their will. Poor communication among nurses, Institutional policies, poor security patient’s abscondence and aggressiveness, amongst others were identified as perceived factors that can hinder application of ethical principles to practice.

Table of Content

• Title Page
• Certification
• Dedication
• Acknowledgement
• Table of Content
• List of Tables
• Abstract

Chapter One:

Introduction

• 1.1 Background of the Study
• 1.2 Statement of the Problem
• 1.3 Objective of the Study
• 1.4 Research Questions
• 1.5 Research Hypothesis
• 1.6 Significance of the Study
• 1.7 Scope of the Study
• 1.8 Limitation of the Study
• 1.9 Definition of Terms
• 1.10 Organisations of the Study

Chapter Two:

Review of Literature

• 2.1 Conceptual Framework
• 2.2 Theoretical Framework
• 2.3 Empirical Review

Chapter Three:

Research Methodology

• 3.1 Research Design
• 3.2 Population of the Study
• 3.3 Sample Size Determination
• 3.4 Sample Size Selection Technique and Procedure
• 3.5 Research Instrument and Administration
• 3.6 Method of Data Collection
• 3.7 Method of Data Analysis
• 3.8 Validity of the Study
• 3.9 Reliability of the Study
• 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

• 4.1 Data Presentation
• 4.2 Analysis of Data
• 4.3 Answering Research Questions
• 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

• 5.1 Summary
• 5.2 Conclusion
• 5.3 Recommendation
• References
• APPENDIX
• QUESTIONNAIRE

Chapter One

Introduction

1.1 Background to the Study

Ethics is an essential element of professional practices especially humanitarian health care professions such as Nursing. It strongly influences patients’ health improvement. Nursing as a profession, respects human values, rights and dignity. Moreover, the fundamental principles of caring include ethics, clinical judgment, and care. It guides the professionals as well as protects the right and bills of patients in different professional jurisdiction. Fundamental to nursing also are the elements of ethics, art, and the knowledge of nursing. Lemonidou et al, (2012) saw ethical commitment to care as an integral part of nursing practice in a nurse- patient relationship.

Human society has some form of myth to explain the origin of morality. At first ethics evolved from the Code of Hammurabi. The book of Hebrew in the Bible which gave an account of the Ten Commandments given to Moses on Mount Sinai by God, then the dialogue Protagoras by Plato (Rogers & Mac, 2011) and later the history of ethics begins with ancient Greek philosophers ( Sophist, Socrates, Aristotle, Epicurus and Stoics). This was followed by the English positivists in Europe, the Christian ethics (though not a scientific term), Hobbes, the father of modern ethics and the twenty ninth century ethics which was more with evolutional concepts but still divided between Utilitarians and Kantians (Rogers & Mac, 2011).

Ethics has many definitions, according to different needs and body of profession. Ethics In nursing according to Ajao, (2017) is viewed as a body of knowledge concerned with issues of moral behaviour and a systematic inquiry into principles of right and wrong conduct, virtue and vice, as well as good and evil, as they relate to conduct and as a set of principles that guides conduct. Furthermore, ethics according to Kjervik and Brous, (2010), provided the expression of values in support of nurses’ empowerment, such as autonomy in practice, beneficence and care-based moral in doing what is best and just for patient. Professional ethics therefore, refers to the use of logical and consistent communication, knowledge, clinical skills, emotions and values in nursing practice (Dehghan, Mosalanejad & Dehghan- Nayeri, 2015). Ethics and ethical practices are in no doubt integrated into all aspects of nursing care.

Ethics and its principles are inseparable and this is why the place of ethical principle in nursing practice cannot be over emphasized. While ethics is the structure of standard of right and wrong, principles are rules that put values into practice. Therefore, ethical principles include those rules that guide our morals, integrity, values character and conduct which serve as a guide to our daily living and help us to judge whether our behaviour can be justified (Joshua, 2019).

Ethical principles vary as viewed by different writers. Saint Mary’s college, (2019) identified three major principles (autonomy, beneficence and justice) based on research on human while Medical protection, (2015) identified four pillars of ethical principles; which are autonomy, beneficence, justice and veracity. Others added by Quora, (2019) are fidelity, truthfulness, confidentiality, non- maleficence, social justice, procedural justice and honesty.

Aina (2017) therefore declared that the ethical principles that nurses must adhere to should include the principles of justice, beneficence, non -maleficence, accountability, fidelity, autonomy, and veracity among others. In influencing patient care from an ethical perspective, a nurse needs an understanding of ethical principles and models. Knowledge of ethical principles, such as autonomy and beneficence, arms the nurse with power to be a major player in the decision-making processes regarding patient care. A nurse who understands ethical principles can meaningfully use this understanding to influence the health care team to apply these principles in their actions and behaviors (Sokoya, 2009).

Caring for people living with mental illness according to Roberts, (2017) is ethically complex. The ethical complexity is due to the ways in which psychiatric disorders affect a person’s experiences. Mental illness can shape one’s development, personality, capacities for love, self-knowledge, self-reflection, and societal contribution (Roberts, 2017). It influences beliefs, feelings, perceptions, behaviors, and motivations across time. It also interferes with one’s ability to speak, to arrange one’s thoughts or to know one’s preferences. It may interfere with one’s desire to eat, one’s ability to find the energy to get up out of bed and one’s will to make it through a day (Roberts, 2017).

Therefore, Aydin and Ersoy, (2017) explained that It is important that psychiatric nurses comprehend different types of ethical issues so that they can resolve ethical problems that they encounter due to moral unpreparedness. Aydin and Ersoy (2017) also emphasized the need for Psychiatric/mental health nurses to understand the ethical principles and determine the key ethical challenges that arise in psychiatric treatment and care so that they may be able to eliminate some possible ethical dilemmas proactively and give appropriate treatment and care ethically.

Mental health nurses deal with patients that pose a threat either to themselves or to others and are adjudged to have committed crimes. In the state of actual or feigned mental illness, medications served (anti-psychotic agents) to the patients may alter their brain chemistry despite the fact that many of the patients are sometimes incapable of understanding the nature, benefits and risks associated with such mediations. Electro- Convulsive Therapy (ECT), use of restraints and seclusion in order to protect the patients and others on the wards despite the need for treatment in the least restrictive environment are sometimes administered to patients even when they refuse or are unable to consent to such treatment (Murphy, Cowan, Street & Sederer, 2017). Also, the mental health nurses are sometimes asked to take part in forensic evaluation of clients that may require them to give evidence, write reports and testify in court (Salihu, 2013). One is then keen to know how much of ethical principle pertaining to psychiatry and mental health practice nurses know and apply or why they do not apply the principles.

Sokoya, (2009) stated that patients who are the beneficiaries of health care are becoming increasingly aware of their legal rights, vis-à-vis nurses’ roles and responsibilities with higher expectations. There is therefore a need for nurses to be ethical and rational without compromising professional standards in rendering their services. It is believed that an awareness of the ethical and legal implications of healthcare will help the individual nurse identify her own moral positions and biases. This knowledge would contribute to, and facilitate effective decision-making when faced with ethical and legal dilemmas and thereby avoiding litigations that can arise from faulty decisions, malpractice and negligence (Kumar & Mehta,2016)

Therefore, this study is therefore embarked upon by the researcher to assess nurses’ knowledge of ethical principles, their application to psychiatry/mental health care and likely to investigate factors that hinders the application of ethical principles to nursing care of people living with mental illness in the central hospital Sapele, Delta State. It is believed that findings from this study when forwarded to the management of the hospital will influence the management decision to put in place necessary action to prevent litigation in the course of nursing care of people with mental illness which can lead to withdrawal of staff license, blacklisting the name of the hospital, financial implication and reduction in internally generated revenue.

1.2 Statement of Problems

Nurses have four fundamental responsibilities which are to promote health, to prevent illness, to restore health & to alleviate suffering. Inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect. Nowadays, health care settings are changing rapidly; nurses are facing ethical challenges in health care due to the current patient and relative awareness of patient bill of right that put nurses at the risk of ethical litigation.

Nurses are also to participate in establishing, maintaining, and improving health care environment and condition of employment conducive to the provision of quality health care (Thompson, 2018). Sokhanvar (2017) reported that nursing awareness and application of ethical principles in patient’s care and clinical decisions were not given much priority as the nurses were not interested in applying ethical principle in Iran. Also, Tefagh (2014) observed that Chinese nurses were more nervous, sad and dissatisfied during and after the work compared to nurses from Switzerland. However, both groups experienced ethical problems of poor communication with patients due to heavy workload.

In the Nigerian context a lot of ethical issues in patient care are raised in relation to application of ethical principles (Salihu, 2013). An observation that stirred the researcher’s interest towards this study was the seemingly lack of the application of ethical principles in the care of people with mental illness observed among nurses in the course of clinical experience. It was observed that psychiatric nurses demonstrated varying behaviour towards the patients while rendering care to patients, such as assault on the patients’, battery and false imprisonment, malpractice, negligence and acts of injustice. This study therefore intends to assess the knowledge and practice of nursing ethics among student nurses in central hospital Sapele, Delta State.

1.3 Objective of the Study

The general objective of this study was to assess the knowledge and practice of nursing ethics among student nurses in central hospital Sapele, Delta State.

The specific objectives of the study were to:

1. Assess level of knowledge on ethical principles among nurses in central hospital Sapele, Delta State
2. Determine the application of ethical principles to care of people with illness by student nurses working in the central hospital Sapele, Delta State.
3. Identify the perceived factors hindering student nurses’ application of ethical principles to the nursing care of people with illness in central hospital Sapele, Delta State

1.4 Research Questions

The study provided answers to the following research questions:

1. What is the level of nurses’ knowledge of ethical principles in central hospital Sapele, Delta State?
2. Do nurses apply the ethical principles to the care of people with illness in the central hospital Sapele, Delta State?
3. What are the perceived factors hindering student nurses’ application of ethical principles to the nursing care of people with illness in central hospital Sapele, Delta State?

1.5 Hypothesis of the Study

• H01: There is no significant relationship between the level of knowledge of ethical principles and their application to nursing practice by nurses in the central hospital Sapele, Delta State.
• H02: There is no significant relationship between hindering factors and the application of ethical principles to practice by nurses in the central hospital Sapele, Delta State.

1.6 Significance of the Study

The findings of this study will show the level of nurses’ knowledge of ethical principles and their application to nursing practice It may also serve as a medium to draw attention of the professional body (Association of Nurses of Nigeria) and relevant agencies to have a picture of ethical situation in the management of people with mental illness

More importantly, the findings from the study may be presented to the Head of Nursing Department in health institutions in order to see to the establishment of Ethical committee if there is none at present to ensure proper monitoring of nurses as they comply with the standards of care in the hospital and as declared by the international codes of ethics for nurses. Nurse leaders may also allow their members to participate in establishing, maintaining, and improving health care environment to be conducive for the provision of quality health care and consistent with the ethics of professional practice.

It is believed that findings from this study when forwarded to the management of the hospital will have influence on the management’s plan and decision in putting up necessary action(s) to prevent litigation against the hospital or the nurse in the course of nursing care of people with mental illness which may be as a result of malpractice and negligence. This may further prevent loss of internally generated revenue to payment of penalty. It will prevent the hospital’s name from being blacklisted and also increase patronage to the hospital thereby increasing internally generated revenue

1.7 Scope of the Study

The research covered all student nurses working at the central hospital Sapele, Delta State. The study will include nurses working in clinical areas of the hospital such as Child and Adolescent, psycho- geriatrics, Drug Addiction Treatment Education and Research (DATER) Unit, assessment, rehabilitation unit corporate ward and the out- patient clinics who are involved in the nursing care. Also, nurse educators who train the post basic psychiatric nursing students at the School of Psychiatric nursing, central hospital Sapele, Delta State will be included.

1.8 Limitation of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

1.9 Definition of Terms

Ethics:

Is the moral standard that judges the conduct of the nurse whether right or wrong when caring for the patient

Ethical Principles:

These are the guidelines that assist the nurse to perform her duty in a professionally acceptable way when caring for people with mental illness. They include; justice, beneficence, non- maleficence, fidelity, autonomy, and veracity.

Ethical Issues:

Problems or situations that arise where the nurse finds himself/herself in a state of confusion, dilemma or tension and need to make a moral decision while caring for a person with mental illness.

Assessment of Nurses’ Knowledge:

Is the evaluation of psychiatric nurses’ understanding of ethical principles.

Nurses’ Knowledge:

Level of the understanding of the nurse about ethical principle

Application:

How psychiatric nurses uphold ethical principles in the care of people with mental illness.

Psychiatric / Mental Health Nurse:

A registered nurse who has undergone training in psychiatric nursing and is licensed by Nursing and Midwifery Council of Nigeria to care for people with mental illness having acquired required training and certification.

Factor:

Situations or circumstances that influence the application of ethical principle to the care of people with mental illness

1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

1. Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
2. Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
3. Chapter three deals on the research design and methodology adopted in the study.
4. Chapter four concentrate on the data collection and analysis and presentation of finding.
5. Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five

Summary, Conclusion and Recommendations

The study was carried out among 250 Student nurses in the central hospital Sapele, Delta State. In all 208 instruments were retrieved out of which 200 were considered fit for analysis. Findings were presented with the use of tables, charts and graph.

5.1 Summary

The study is a descriptive survey titled assessment of nurses’ knowledge of ethical principles and their application to practice in a central hospital Sapele, Delta State in Nigeria.The purpose of the study was to determine the nurses’ knowledge of ethical principles and how the principles are applied to the care of people with mental illness in the central hospital Sapele, Delta State, Nigeria. The study also identified the factors that do influence the application of ethical principles to the care of people with illness as perceived by the nurses.

The research is a quantitative study using descriptive design. Self-structured questionnaire was the instrument for data collection aimed at eliciting data from all available and consented Registered Psychiatric nurses on knowledge of ethical principles and the application to practice at the central hospital Sapele, Delta State.

Elicited responses were on; respondent’s social-demographic data, knowledge of ethical principles, their application to practice and perceived factors that influence the application of ethical principles to the care of the ill.

Bloom’s Taxonomy theory on learning objectives was applied to the study. It emphasized and applied the first three levels of Bloom’s Taxonomy framework which are knowledge, comprehension and application. It is related to the study in that when nurses gain knowledge of ethical principle from any source of information they will with understanding apply the principles to the care of their patients

The findings from the study showed that the respondents are knowledgeable about ethical principles and that they positively apply the knowledge to practice in their care of people with mental illness. They were also able to identify some of the factors that influence the application of ethical principles in the care of people with mental illness. The stated hypotheses were tested and showed a significant relationship between respondents’ knowledge of ethical principles and their application to nursing practice and a significant relationship between influencing factors and the application of ethical principles to practice.

Finally, the findings were presented in tables, charts and graphic. They were analysed discussed, summarised and necessary recommendations made. and union leaders.

5.3 Conclusion

Ethics is about the values that should be respected by all healthcare workers while interacting with individuals, families and communities. Ethics may sometimes be considered a scary term by some healthcare professionals because it is a word that may bring to mind an accusation of wrongdoing or mistakes, but this is not the case. It provides a set of standards for behavior that helps us decide how we ought to act in a range of situations. Ethical principles are values and characters that the nurse is ensured to follow as standard and they include; justice, beneficence, non- maleficence, fidelity, autonomy, and veracity.

The knowledge of ethical principles in the care of the patient is a necessity of all practicing nurses and remains one of the most important components for delivering quality healthcare for individuals, families and the community at large.

It has been observed that the application of ethical principles in a psychiatric setting is a tasking experience for psychiatric nurses as some of the principles need to be critically considered in the area of confidentiality, inform consent, admission non maleficence, veracity and other attributes in relation to patient care.

Conclusively, adequate knowledge of ethical principles helps in the application to practice in every sphere of nursing practice including mental health and psychiatric nursing. In order to further enhance the application of ethical principles to practice and in the care of people with mental illness therefore, all stake holders such as the government, management of health care facilities, nurses and association leaders must put in place necessary support for nurses in their care of patient in order to achieve a laudable attribute and prevent legal dilemma and law suit that may implicate the nurses and the health care facilities.

5.4 Recommendation

Findings from the study revealed that the nurses have adequate knowledge of ethical Principles and do apply them to practice. In view of this, nurses and stake holders have a role to play in upholding this laudable attribute. It is in the light of this that the under listed have been recommended:

1. Adequate well-trained security staff and crisis intervention team to assist the nurses during crisis situation should be made available in hospitals
2. All nurses’ leaders are to ensure that there is an ethics committee in the nursing department of their respective institution and ensure adequate supervision of nursing practice. Also, the nurse leader should ensure that good condition of service, therapeutic environment for practice, staff welfare package and security facilities are in place for effective and efficient nursing practice and to encourage the nurses as they daily carry out their professional calling.
3. Adequate well-trained security staff and crisis intervention team to assist the nurses during crisis situation should be made available in hospitals
4. Supervisory nurses, audit and ethic committee of nursing departments in health institutions should identify and appreciate outstanding nurses in practice and put in place discipline measures for those that are found herring.
5. The nurse clinician leaders should understand the peculiarity of their field of practice or specialty and ensure that necessary, security, hazard prevention, instrument and conducive environment for nursing care of patient are made available for the nurses. Also, the duty roaster for nurses especially in a psychiatric hospital should be made in a way that it will ensure adequate number of nurses are on duty on the respective shift and also that experienced psychiatric nurses are always on duty to work with new nurses. Moreover staff [especially nurses] advocacy group should be put in place to support and assist nurses in cases of ethical dilemma, ethical problems or a case of law suit. In-service training and retraining of nurses should be an ongoing exercise in the clinical area and this should include topics on nursing ethics.
6. All association and union leaders should make programs, such as seminars, workshops, conferences and lectures base on ethics and ethical principles in nursing care of the mentally ill a continuous activities in order to refresh the memory of the older nurses who do not have adequate knowledge of current trends in the application of ethics to practice and to teach the younger nurses on how to apply theory to real life situation in practice. They should also stand and negotiate with the government on the welfare package of their members in the area of hazard allowance, insurance and security in the clinical area. Each unit leaders should negotiate base on the peculiarity of their institution and specialty of practice. They should also ensure good interpersonal relationship with their institutional head so that necessary need of their members can be met respectively.
7. Finally, the bill on mental health care that is current under review by the legislators should be hasten up by the union so that a new bill on mental health care can be made available to replace “The Lunacy Act” (Nigeria)1958, Cap No. 112, which was derived from the British Asylum law as a result of the colonial relationship between the two countries and the Mental Health Bill which was to repeal all other previous mental health legislations in Nigeria in line with World Health Organization’s recommendations which unfortunately after public hearing has not been made into law since 2009.

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