I'm just a student but an issue came up in class that really had me We were discussing med administration and lady partsl suppositories. One of the male students in class asked if he would "have" to do that for a pt., or if he could delegate to another nurse. The part that most surprised me was that my nursing instructor told him it was fine, she had male nurses she worked with who refused to insert foley's on females and other procedures involving the peri area of women.
This just seems so unprofessional to me. A pt. is a pt. and if they need care, it's our job to provide it. I understand that we're in a crazy litigious society and she mentioned one male nurse who brought a female aide in when doing foley's and things (I understand that a lot more). But honestly, the tone from this male student and one other in class was more like "that's so gross, I can't handle it" rather than "I'm scared for my license".
Is this common? I've had male OB/GYNs care for me personally and didn't think twice. I guess it just made me uncomfortable the sexual implication that they seemed to be projecting onto a medical procedure. Am I just out of touch?
If personal ethics are in conflict with professional ethics then one has pretty big problem on one's hands.
I agree; but your answer is a little too fast and slick.
The first problem is in clearly, articulately establishing the profession's ethics. The ANA Code of Ethics is suggestive, not obligatory. Legally and morally we are bound to practice in an ethical manner. But we are no more bound to the specific details of the ANA Code any more than we are obliged to be members of the ANA. There does, of course, then arise another problem. (All ethics is a study of a chain of problems, and the compromises or reconciliations of conflicting values and problems.) If not ANA, then what? But again, one can't just pull the ANA Code out of a drawer, wave it in someone's face, and say 'here's the standard for the profession.'
I am intentionally ignoring here the pragmatic issue. That is, a lawyer in court probably would pull out the ANA Code and tell a jury that is the professional standard. For that purpose, there may even be some truth to that. But we're talking ethics here, not litigation.
The second problem is determining if, in fact, there was an ethical breach when the nurse saw to their own ethical need. As I noted earlier, there are a number of concurrent issues that arise in how the nurse's choice effects the patient and colleagues. But not every effect is deleterious, or enough so to say that it is really a moral problem.
In all cases, it should be up to the patient if they are able to make that decision. A male should be accompanied by a female if at all possible, although we all agree that it is NOT always possible.
We have two males in our program, and have never run into a problem, until this semester. When we did out OB rotations, the nurses there were very adamant that the males not be anywhere near a postpartum or laboring woman. Kicked them out during assesments, the works. Said that that hospital is against that..although they employ males elsewhere in the hospital. These guys have NO DESIRE to get anywhere OB but i still thought i was tacky the way they handled it. So, for our rotations, the guys pretty much sat out in the hall and did nothing...fine by them, but to me it was a waste of their time and the staff's if they werent doing anything.
In my personal experience, my male OB doctors, who delivered all of my children, were much more gentle and had a better bedside manner than the female in the group.
I think nurses that abuse religious exclusion are likely to be more vein than faithful. Abortion and euthanasia are clearly the most powerful religious conflicts in nursing. Specific cultural, ethnic or religious practices are well managed by the medical community as a whole. Nurses that find themselves unable to provide appropriate and respectful care for pts because thier own interpretation of what is acceptable to their "religious" beliefs, are simply making excuses to keep from getting their hands dirty. I am a christian and strongly believe that outside of willfully taking a life or causing intentional physical or emotional harm, my faith doesn't exclude me from serving all pts needs and respecting their beliefs. I don't have to agree with or promote my pts ideals or beliefs( no matter how offensive or unusual I think they may be). I am a student and can't back my statements with hands on experience but find it hard to get caught up in someone elses beliefs when they have very little impact on decisions I make and have to answer to God for. I can't impose my beliefs on my pts even if I feel compelled to share the word with them.I think the nature of nursing, especially in such diverse times, requires more attention to promoting wellness anyway possible than getting hung up on beliefs that define acceptable practices.If a pt subscribes to methods I personally oppose and those methods are legally tolerated and promote their sense of well being, how do I harm myself by fulfilling my obligation as a nurse?
I would appreciate any feedback I can get. As a student, I feel this is subject that is vaguely adressed in an open, honest theory discussion.
I'm lucky in that nothing that comes out of any orrifice of the human body male or female grosses me out. I've dug out my fair share of impractions.
I also do not give lady partsl suppositories or insert foleys on alert and oriented females. Because if I have to drag a female witness, (I always have a witness just like a male doc doing a pelvic exam would), then the female can do it for me and I'll do something for her in exchange.
I'm more flexible with confused or comatose patients because there isn't that element of being afraid of false accusations or the patient being uncomfortable with a male nurse being that intimate.
Right or wrong, judge me if you will, but this is how I practice and it's worked well for me.
Nurses that find themselves unable to provide appropriate and respectful care for pts because thier own interpretation of what is acceptable to their "religious" beliefs, are simply making excuses to keep from getting their hands dirty.
That seems like a facile and uninformed judgement. As I mentioned earlier, there are cultures and religions that have rather clear notions of an individual's obligations that are far more detailed and specific than what most folks in America are aware of. In some cases this includes standards of interpersonal conduct.
Let me give you a brief (not thorough at all!) example of what I am talking about, but only peripherally related to our original discussion here.
Traditional Judaism has a very detailed legal and ethical system. In addition to the core commandments and laws (which is already much more specific and detailed than what you as Christian would be familiar with) covering every area of human activity, there is a literature of case studies ('responsa') and precedents from over 2000 years of scholarship and application that would rival what you'll find in any American law library. On one Jewish religious forum right now, for instance, is a wide ranging discussion of property law and copyright issues. The cases brought up as part of the discusson and analysis are from all over the world and span about 1000 years. And this is by way of clarifying one's religious obligations, since that culture sees interpersonal relations and dynamics as part of one's religious obligations.
So, one discussion that comes up is may a Jew give an injection to their parent? There are several competing values here. First off, we assume no acute danger to life; otherwise that overrides the rest of the discussion. Now, there is an obligation to do acts of kindness, including patient care. But the specific laws regarding honouring one's parents in Judaism include avoiding anything that would cause them distress or discomfort. An injection and the like causes pain, even if momentary. Then too, the prohibition of striking one's parent or causing injury is more severe than for someone else. So if it is therapeutic, is it then permissable? If someone else is available to provide the treatment, am I obligated to ask them to step in? There is a practical summary of this question here http://books.google.com/books?id=aaklGZAID08C&pg=PA773&lpg=PA773&dq=jewish+law+giving+a+parent+an+injection&source=bl&ots=MM23EQSUUr&sig=ZBZt8rlgBrsU7uPwA3wKq8j0xkE&hl=en&sa=X&oi=book_result&resnum=3&ct=result.
You, as a Christian, probably wouldn't be confronted with such a specific and scholastic set of considerations for that discussion. But other factors might come up that I, as a non-Christian, can't anticipate. Or, you might not even consider that a question!
This is not something that a conscientious traditional Jew would decide on their own. It is already established as a part of their obligations in Judaism by thousands of years of practice, culture, and rabbinic guidance. Similarly, the Muslims have Sharia. I don't know for sure, but other cultures may also have fairly specific and detailed standards of obligation and behaviour.
And I dare say that, despite your assertian that 'as a Christian' certain things are clear to you, you must be aware that in Christian America there is quite a range of churches and denominations with a range of opinions on some of the very issues that concern us. You mentioned only two. The Catholic church, Russian Orthodox, the various Protestant denominations, and independant churches have taken varied stands on a whole variety of healthcare issues. So even your clarity can apply no further than the space you stand on.
Nursing schools barely have time to make us aware of cultural variety. And they only focus on the variety among our patients. There is also cultural variety among the practitioners. We need to not only be aware of that, we need to intelligently consider what that means and what we do with it. Our answers and solutions need to well thought out and considered. And most of us are woefully uneducated and unpracticed in ethical matters and methodologies.
Okay, off of my soapbox for another respite from my diatribes...
Unless the patient requests a female nurse...Isn't this the same as stating I won't treat a patient with "X" diagnosis??
1Learning
:typing
Great question/thought.
I think it depends on why you didn't want to care for that patient. If you just think that 'perianal care is icky', then I would think it is as bad or worse than if I refuse to treat someone with 'X' Dx.
But what if your understanding of the requirements of human dignity includes a need to avoid when possible unnecessary intimate encounters with the opposite sex who you are not married to? What if your religion specifically prohibits such casual (though this would not be casual) or avoidable encounters? Then I wouldn't think it is the same at all; though you might have a real practical problem.
Keep in mind, please, I am not advocating any one position. I am arguing that we don't think about ethical problems very well, if at all. I am arguing also, that those dilemnas exist and that the providers have to be considered as well as the patients.
But what if your understanding of the requirements of human dignity includes a need to avoid when possible unnecessary intimate encounters with the opposite sex who you are not married to? What if your religion specifically prohibits such casual (though this would not be casual) or avoidable encounters? Then I wouldn't think it is the same at all; though you might have a real practical problem.
entering nursing as a bedside nurse, i don't understand how anyone could expect to avoid performing personal care on a pt, regardless of gender.
if one's religion prohibits this, i would think that nursing would not be a realistic profession to pursue.
I'm willing to bet these male nursing students you speak of have no or very limited experience in the nursing field. (Obviously they aren't RNs, but I'm referring to being CNAs or LPNs or whatever).
Thats very insightful. perhaps my inexperience and my lack of knowledge outside of my faith leaves my unable to appreciate the vast number of conflicts that can arise from religious beliefs outside my own. I think my point was lost. NURSES WHO ABUSE RELIGIOUS EXCEPTION.Perhaps some religions would conflict with a majority of nursing obligations. An aspiring nurse from this religion, strong in the ways of their faith, would surely be aware of this fact BEFORE investing the time , energy, and finance required to enter the nursing profession.Why take on an oath to serve in a specific manner if your religion conta-indicates many of the activities required to fulfill the standards of care? Should THIS person be allowed to sift thru reponsibilities and strain the rest of the staff. How much task swapping can you do without endangering continuity of care? I have studied a small bit of the cultural/ ethical/ religious aspects in nursing. Not nearly enough to take shots at anyone elses knowledge and definately not anyones beliefs. Just generalizing my concern over abuse of this right.My instructor only specifically cited abortion as an acceptable reason to dismiss yourself from direct care of an assigned pt. Can you give me some more, less obvious examples?
entering nursing as a bedside nurse, i don't understand how anyone could expect to avoid performing personal care on a pt, regardless of gender.
if one's religion prohibits this, i would think that nursing would not be a realistic profession to pursue.
leslie
If it were that simple, I think you'd be right.
But my presentation was more nuanced than that. As aware as I think I am, I'm no expert on all the cultural varieties out there. So I used words like 'unnecessary'. So this female nurse of culture X might say 'of course, if the patient will be left untended I'll take care of the Foley, etc. But if a guy is available and able to step in, that would be preferable to me.'
Cultural mandates, mores, and obligations aren't usually simply black and white, yes or no. There are often hierarchies of values to consider, and levels of obligation or severity of transgression or violation. Of course, sometimes even a member of a particular culture doesn't have a sophisticated enough knowledge and understanding to know what their possibilities are. Sometimes they think they have a problem, when a solution is right at hand. Sometimes they think they have no problem, when in fact they have grossly violated some norm of their culture or religion. Some cultures may teach that all religious or cultural considerations are suspended for caregivers (though I haven't yet come across that); but I know that certainly is not the case with others.
[This is a bit tangential, but of interest here as well. Sometimes we confuse the mandates of one culture with another. A few years ago I was writing a paper on medical ethics. I came across the transcripts of a television documentary on religion and medicine. A professor of religion and ethics at Harvard stated there that since Jews and Muslims are prohibited from eating pork, they also could not have porcine derivative medicines or transplants. The logic is pretty simple and straightforward, really. The only problem is, that concerning Jews at least, it is dead wrong! This is a well-discussed topic in Jewish law, and it is clear that there is no prohibition whatsoever for a Jew to have a porcine transplant or use porcine medications (at least non-PO) such as earlier insulins or heparin today. This 'scholar' is not knowledgeable in Jewish law and how such determinations are made; but he didn't mind making pronouncements like an expert. He just forged ahead with what seemed logical to him. Interestingly, Muslim scholars have also come out allowing this, though I think that may be a fairly recent clafication in Islam. The earlier position apparently was to prohibit porcine products for Muslims. I don't know where they are now on porcine tissue. See http://www.vaccinesafety.edu/Porcine-vaccineapproval.htm]
the bottom line is in the job description when you apply for your job. Can you do X, yes or no? If you can't, you don't get the job. That's not religious discrimination. Religious discrimination is when someone in human resources decides not to hire you because you are a affiliated with X religion (even if you are able to do the job). If you can't do the job, you don't get it. Bottom line.
We were discussing med administration and lady partsl suppositories. One of the male students in class asked if he would "have" to do that for a pt., or if he could delegate to another nurse. The part that most surprised me was that my nursing instructor told him it was fine, she had male nurses she worked with who refused to insert foley's on females and other procedures involving the peri area of women. 
Medic09, BSN, RN, EMT-P
441 Posts
I agree; but your answer is a little too fast and slick.
The first problem is in clearly, articulately establishing the profession's ethics. The ANA Code of Ethics is suggestive, not obligatory. Legally and morally we are bound to practice in an ethical manner. But we are no more bound to the specific details of the ANA Code any more than we are obliged to be members of the ANA. There does, of course, then arise another problem. (All ethics is a study of a chain of problems, and the compromises or reconciliations of conflicting values and problems.) If not ANA, then what? But again, one can't just pull the ANA Code out of a drawer, wave it in someone's face, and say 'here's the standard for the profession.'
I am intentionally ignoring here the pragmatic issue. That is, a lawyer in court probably would pull out the ANA Code and tell a jury that is the professional standard. For that purpose, there may even be some truth to that. But we're talking ethics here, not litigation.
The second problem is determining if, in fact, there was an ethical breach when the nurse saw to their own ethical need. As I noted earlier, there are a number of concurrent issues that arise in how the nurse's choice effects the patient and colleagues. But not every effect is deleterious, or enough so to say that it is really a moral problem.