The Principle of Respect and Ethics: A Pillar of Psychiatric Nursing
The nursing profession works on a set of ethical guidelines in order to maintain a standard of holistic care for patients. Similarly, in psychiatric settings, as patients cannot fully express their own rights and decisions (Choe, Song & Jung 2012) it is the integral responsibility of a nurse to help them in this regard. Therefore, it is necessary for a psychiatric nurse to have a complete understanding of the code of ethics. The nursing code of ethics includes various principles such as beneficence, non-maleficence, justice and confidentiality. Nevertheless, the most important and basic principle is respect towards the patient. It is so because if a nurse is not respecting her client internally, her behavior will portray the same and she will not be able to develop a trusting relationship with the client (NICE clinical guideline, 2011). This would ultimately hinder every aspect of care towards the client.
During my clinical rotation of mental health course I encountered a 56 year old male patient suffering from Mania. He used to talk excessively, mimic different voices and sing songs in his language. As this was my first experience with a psychiatric patient I found it a bit atypical and funny. My colleagues and I had similar feelings.
We all used to tag him as the funniest and talkative person. Moreover, we used to joke and laugh at him in our clinical group meetings. Later, when I reflected back on this scenario I realized that as a nurse it is my ethical responsibility to respect the patient. Regrettably, in this case I was unable to fulfil my ethical obligation towards the patient. This incident persuaded me to explore more and refine my knowledge about respect as a nurse’s ethical duty towards the patient.
The concept of respect in psychiatric care is not new. The founding mother of psychiatric nursing, ‘Peplau’ also regarded respect as a part of a psychiatric nurse’s role. While considering the concept of respect in mental health care one cannot separate work of Carl Rogers. His theory describes four core aspects on the necessity of respect in mental health care. He firstly highlights that every individual has the ability to live a meaningful life.
If the treatment includes interpersonal asset of respect, then this will lead to personal development, growth and wellness of the client. Secondly, he emphasizes on using the term “client” instead of “patient”. According to Rogers, implementing this in health care would enhance the capacity of a health care professional to see the humanness of the client. Thirdly, Rogers regards congruency, empathy and respectfulness as the three most important qualities of mental health professionals. Lastly, he stresses that when a client encounters a respectful, congruent and empathetic health professional then this supportive atmosphere guides the person towards becoming a fully functioning individual (Cutcliffe&Travale, 2013).
If I relate these aspects to my scenario, firstly I should understand that my client possesses the right to live a meaning full life without being judged for his atypical behavior which is actually a part of the disease process and not his deliberate action. Secondly, it is my ethical responsibility as a nurse to respect my client, even when I am not with him because as a human being it’s his basic right to receive respect. Moreover, it is important to understand the person under my care is not inferior to me neither am I superior to him so empathy instead of sympathy should direct my care. Furthermore, if I demonstrate respect towards my client through my care and behavior this would strengthen my relationship with the client. This consolidation of my therapeutic relationship would eventually guide me towards delivering a better care.
Understanding the importance of respect, many organizations of the world have developed policies for the provision of respect in mental health care. The American Nurses Association (2010) has regarded respect as the first provision of their Code of Ethics for Nurses. Similarly, College of Registered Psychiatric Nurses of Alberta (2013) also considers respect as an integral part of a nurse’s duty.
Likewise, in Pakistan the development of Mental Health Act (2001) and National Mental Health Policy has served as a milestone towards provision of culturally appropriate mental health care integrated with respect and dignity (Bhanji, 2013). Besides, Pakistan Nursing Council (2006) has included courses such as Nursing Ethics and Mental Health Nursing in their baccalaureate program. The underlining purpose is to make nurses identify with the ethical principles such as respect and to provide knowledge of proper code of conduct which would guide their actions while caring for the patients.
Even though, mental health legislation is present in Pakistan, it lacks implementation due to instability of government (Jalaluddin&Jalaluddin 2012). Therefore, it is necessary for the government policy makers to reinforce and ensure implementation of policies from primary to tertiary level. Along with the development of policies at national level the adoption of a set of rules of the mental health ordinance at the institutional level is of high importance (Bhanji, 2013). In addition to the development of policies at the national and organizational level continuous monitoring of health professionals is necessary to ensure their compliance with the principles described in these policies.
It has been commonly observed that despite the development of policies along with the provision of education, the application of the principle of respect is somewhat lacking in actual practice. In relation to Pakistani society, one of the reasons causing this skirmish in realistic application of the principle of respect could be the influence of existing societal stigmas on a nurse’s decisions. For instance, it is a common believe in our society that mental illnesses are the punishments that result from ill deeds and behaviors (Ciftci, Jones & Corrigan, 2013). When a nurse believing this school of thought encounters a psychiatric patient, she would judge the patient as a sinner rather than her client who requires her help and care. Therefore, it is necessary for a psychiatric nurse to have a complete understanding of mental health diseases to avoid influence of such stigmas which negatively impact client care.
Moreover, absence of self-awareness among nurses can lead to lack of application even with education. Dziopa and Ahern (2008) emphasized that self-awareness helps to form and demonstrate proper relational skills with the patients. This means that to show respect towards the patients a nurse first needs a clarification and modification of her own values. So, it is an individual responsibility of a nurse to clarify her values about provision of respect towards the client. This would help in her better application of the received ethical education into practice. It is clear therefore, that along with development of policies, an individual’s own efforts to modify thinking and develop self- awareness are necessary to depict ethical principal of respect in the practical care.
In conclusion, as health care professional it is our ethical obligation to respect our clients. Therefore, to avoid violations of such ethical principles it is necessary to develop policies at the national and organizational level. Furthermore, it is very important to ensure its implementation as well. Nevertheless, the most important requirement is development of self-awareness and modifying our thinking at the individual level.
Bhanji, S. M. (2013). Respect and Unconditional Positive Regard as Mental Health Promotion Practice. Journal of Clinical Research and Bioethics, 4(3), 2155-9627. doi:10.4172/2155-9627.1000147
Choe, K., Song, E.-J., & Jung, C.-H. (2012). Ethical Problems Experienced by Psychiatric Nurses in Korea. Archives of Psychiatric Nursing, 6(6), 495-501.
Ciftci, A., Jones, N., & Corrigan, P. W. (2013). Mental Health Stigma in the. Journal of Muslim Mental Health, 7(1), 12-32.
College of Registered Psychiatric Nurses of Alberta. (2013). Code of Ethics & Standards of Psychiatric Nursing Practice.
Cutcliffe, J. R., &Travale, R. (2013). Respect in mental health: Reconciling the rhetorical hyperbole with the practical reality. Nursing Ethics, 20(3), 273–284.
Dziopa, F., & Ahern, K. (2008). What Makes a Quality Therapeutic Relationship in Psychiatric/Mental Health Nursing: A Review of the Research Literature. The Internet Journal of Advanced Nursing Practice, 10(1). Retrieved from http://ispub.com/IJANP/10/1/7218
Jalaluddin, R., &Jalaluddin, S. (2012). Factors Influencing Mental Health Policy Process In Pakistan. Journal of Nursing, 1(1), 39-43.
NICE clinical guideline. (2011). Service User Experience in Adult Mental Health: Improving the Experience of Care for People Using Adult NHS Mental Health Services
Retrieved from: http://www.nice.org.uk/nicemedia/live/13629/57534/57534.pdf
About the Author: Khadija Shafiq Dossa is a recipient of Bachelors of Science in Nursing degree with Honors from Aga Khan University School of Nursing and Midwifery, Paksitan in year 2015. She is currently working as a nursing intern at Aga Khan University Hospital and her major interests include Public Health, Adolescent Health, Mental Health and Sexual and Reproductive health. Khadija can be reached at [email protected]
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