Nursing Ethics

I am excited to be back in classes for the Spring semester, and inspired by my reading last night which matches closely with my understanding of Buddhism.  Three paragraphs discussed the "three basic ethical principles of nursing": Respect for a persons right to self-determination, beneficence, and justice. 

Self Determination: Treat patients as autonomous individuals capable of making their own decisions.  My fiancee recently described working with a parent who was trying to get their child to stop playing with water.  I was impressed with her ability to hold the parent's point of view as well as the child's in the interaction that followed.  My reaction to hearing the situation was "I would have been like, 'it is okay if they play with water, we can clean it up later."  However, such a response would have undermined the parent's authority and potentially confused the child if there is an expectation around such play that will be enforced when the child is not in that setting.  Likewise, patients have different frames of reference from my own and it is not only counterproductive to impose my beliefs on them but also disruptive to their health and overall well being.  Buddhism takes the long-view.  The Buddha was enlightened some 2500 years ago and set out to "save all beings," however he did not exhaust himself trying to force people to accept one "way" of doing things.  In one story he sits in silence as a learned man sits and questions him, finally leaving convinced that the Buddha is a sham and has nothing to offer.  When asked why he was silent by his disciples the Buddha replied that the man didn't really want to hear he just wanted to argue.  It was not appropriate to teach what would not be heard.

Beneficence: Work for the benefit of the patient.  This includes the axiom "first, do no harm" common among doctors, and includes a wider sphere of active participation in ensuring the patient's well-being.  I can see how the art of nursing becomes important as potential conflicts exist between my personal and cultural norms and standards and the patient's right to self determination.  I am beginning to see my role as educator and advocate as potentially more fluid and dynamic than I thought.  Perhaps each patient brings a new frame of reference and boundaries within which my work to benefit a patient is somewhat constrained.  I say "somewhat" because I think it is also my role to explore these boundaries with patients and push to expand them where appropriate.

Justice: Treat all patients equally and fairly.  I referred to this in an earlier entry in which I saw the orange jumpsuit of prison patients as a kind of meditation bell.  A reminder to slow down and give the best care possible regardless of cultural learning that disregards prison populations, lower social classes, and minorities in general.  A number of readings in my program have also highlighted the role of nurses not only in their care settings but also in their communities.  This is a very Buddhist teaching.  If a problem exists in a community or nation that manifests as a recurring problem in a healthcare setting it is the nurses role to address the larger issue and not just treat the manifestation in the healthcare setting.  Cardiovascular disease among African-Americans, the obesity epidemic, low levels of health education... These are areas that can be addressed both in the microsystem of bedside or outpatient care as well as through advocacy, research, democracy, community involvement, mentoring, etc.

I am looking forward with beginners eyes and eagerness to develop my professional practice.  When I started this program I was excited by the calls from my teachers to view our profession as fluid and full of continuous learning.  I don't think that I will ever be "done" as a nurse.  That is one of the most exciting things about this profession.

New Years Wedding

“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”   - Marianne Williamson (often attributed to Nelson Mandela)

This reading was shared at a wedding I recently attended.  It has been a touchstone for me since then and I find myself returning to it for strength.  The other day I thought "it would be easier for me to do this if I had known someone else to have done it."  Then this quote popped up and I thought, "If I do this I can be that example for someone else."  That was hugely self-empowering.