TORG-MAG Vol 1 Issue 1, PP. 15-16
By Blessing C. Ugwu (Secretary, TORG Executive Council)
Abstract
This article aims to create a better understanding of the challenges perioperative nurses encounter in the operating theatre and how they respond to these value conflicts when they arise. The nurse who finds himself or herself in a value conflict tries as much as possible and with consideration for the patient to offer professional care.
However, against their own will and personal conviction, they are prevented from giving the good care they desire to offer and this often leaves them with feelings of guilt, internal conflict and regrets for failing to prevent the value conflict.
Keywords: Patient care, value conflicts
The goal of every perioperative nurse is to offer quality care to the patient with full respect for human dignity and ethical values (i) . Their goal notwithstanding, they experience value conflict because they have staff members (ii) who deliberately and non- deliberately behave in ways that are dishonoring and unacceptable both to patients and other staff members . The question therefore is what do perioperative nurses do to deal with value conflict and what is value conflict?
What is Value conflict and how do perioperative nurses handle value conflict?
These are conflict that arise from differing world views. It occurs when one group’s most cherished belief about the way to live differs radically from the values held by another group. When this happens, it often leads to the development of radically different or incompatible goals that is often referred to as value conflict (iii) . Perioperative caring has been defined as: ‘those nursing activities performed by the professional nurse in the preoperative, intraoperative and postoperative phases of the patient’s surgical experience. The three phases of surgery are simply periods of time when prescribed nursing actions take place. ‘Peri’ refers to the time around surgical procedures (iv).
Perioperative nursing was introduced in the U.S. in the 1970s (v) and since perioperative practice is organized and managed differently in Sweden compared to the U.S, perioperative nursing had to be defined in relation to Swedish conditions as: Perioperative nursing includes the perioperative caring of the nurse anaesthetist or operating theatre nurse, as well as the perioperative dialogue in the caring process, i.e. the nurse’s pre-, intra- and postoperative dialogue with the patient, as well as surgical treatment and techniques, i.e. the practical methods the patient is exposed to in order to improve health and save life. Perioperative nursing can also be seen as a way to lead and organize the work performed within an operating theatre (vi). To handle or deal with this challenge, the caring nurse must know and understand, according to Von Post (1998) that ‘’the caring nurse is essential to the development, growth and survival of the human being.’’ He further explains that ‘’Professional caring implies a nurse has learned caring through education and the professional caring nurse cares for the patient, is loyal to him and follows the principles behind the duty to protect a weaker person.’’
Furthermore, the AORN’s Ethics Task Force has introduced specific perioperative nursing explications that is in line with the nine provisions in the American Nurses Association’s (ANA’s) Code of Ethics for Nurses with Interpretive Statements. ‘’The ANA code expresses the moral commitment to uphold the goals, values, and distinct ethical obligations of all nurses. The ANA code and AORN’s explications for perioperative nurses provide a framework in which perioperative nurses can make ethical decisions. The code of ethics establishes a nonnegotiable ethical standard for the nursing profession. It demonstrates accountability and responsibility to the public, other members of the surgical team, and the profession overall (vii).
Past Research
Several studies have shown the regularity of value conflict in perioperative caring environments among perioperative nurses. For instance, a study result revealed that Value conflicts arose when operating theatre nurses were not allowed to be present in the perioperative nursing process, because of current habits in perioperative practice. The patient’s care became poor when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient’s best (viii). In another study involving 48 anesthetics and 76 operating theatre nurses, four kinds of problems or challenges were identified as value conflicts in perioperative practices and they include; those arising as value conflicts in the intraoperative phase of surgery; those emanating from the patient’s right of self- determination; those arising in caring for patients; and those resulting from the allocation of scarce resources and the demands of increased effectiveness (ix).
There are also instances when a nurse feels insecure about whether informed consent has been given or when infants are being operated on without administering anesthetic(i).Other studies revealed the importance of perioperative nurses’ care in the operating theatre with highlights on patients experiences with soothing music, and others on the intraoperative nursing procedures to provide confidence-based relationship with the sole purpose of guaranteed patient safety during their stay in the operating theatre (ix).
Brief Discussion
Operating theatre nurses often find it difficult to make ethical decisions even though there are very much necessary when caring for surgical patients in practice. This is why they must be able to recognize value conflicts and take appropriate actions as much as possible. They are responsible for taking, morally, clinically and technically sound decision suitable for the patient who is undergoing treatment. In order to fully understand the responsibility of the operating theatre nurses whether medically and morally, they should be able to ask these questions where necessary. The technical or medical aspects of nursing practice answer the question, “What can be done for the patient?” The moral component involves the patient’s wishes and answers the question, “What ought to be done for the patient?” ii.
At this juncture, it is worthy of note that an ethical dilemma is unquestionably different from a value conflict situation. According to Von Post (1998), ‘’An ethical dilemma arises when it is difficult to carry out a task and a value conflict arises when a nurse becomes witness to another member of the staff behaving in an impolite, uncaring way and thereby violating the patient’s dignity or when colleagues prevent her from giving the good care she wants to give’’. In order to deal with the challenges of value conflicts and ethical dilemma, the AORN has put together some standards that focus on both the professional and the patient.
Some of these standards by AORN to help the perioperative nurse internalize and influence the values of the profession include; completing continuing education courses, developing and presenting an educational offering, reading professional journals and newsletters, writing an article on a clinical or professional issue, maintaining membership in AORN, submitting a Willingness-to-Serve form, participating in chapter and state council activities, and many morevii This will help the nursing staff to offer quality care to the patient thereby promoting the laws and values of the organization. As it obvious that value conflicts do not promote the security of the patient, instead it violates his/ her dignity and respect.
Conclusion
In conclusion, value conflict is a situation the operating theatre nurse has become a part of against his/her will as they are not permitted or allowed to give the care they want to offer to the patient. An ethical dilemma is different from value conflicts. ’An ethical dilemma arises when it is difficult to carry out a task and a value conflict arises when a nurse becomes witness to another member of the staff behaving in an impolite, uncaring way and thereby violating the patient’s dignity or when colleagues prevent her from giving the good care she wants to give.’’
References
- Von Post, I. ‘’Perioperative Nurses’ Encounter with Value Conflicts’’. Scandinavian Journal of Caring Sciences, 12 (1998): 81-88. https://doi.org/10.1111/j.1471-6712.1998.tb00480.x
- Blomberg, A. C., Bisholt, B., & Lindwall, L. ‘’Value conflicts in perioperative practice’’. Nursing ethics, 26(7-8), (2019) 2213–2224. https://doi.org/10.1177/0969733018798169
- Lindwall L. & von Post I. ‘’Habits in perioperative nursing culture’’. Nursing Ethics, 15, (2008): 670–681.
- Michelle Maiese. ‘’Moral or value conflicts’’.(2003) https://www.beyondintractability.org/essay/intolerable-moral-differences
- Association of Operating Room Nurses. AORN standards and recommended practices for perioperative nursing. Denver: Association of Operating Room, Inc, 1985
- Cecil A. King, Catherine Broom. ‘’Ethics in Perioperative Practice—Values, Integrity, and Social Policy’’. AORN Journal 76 (2002):1047–1053. https://doi.org/10.1016/S0001-2092(06)61007-7
- Blomberg A-C, Bisholt B, Lindwall L. ‘’Value conflicts in perioperative practice’’. Nursing Ethics. 26(7-8) (2019): 2213-2224. doi:10.1177/0969733018798169
- Von Post I.’’Exploring Ethical Dilemmas in Perioperative Nursing Practice Through Critical Incidents’’. Nursing Ethics. 3(3) (1996): 236-249. doi:10.1177/096973309600300306
- Lillemor Lindwall, Von Post.‘’From Practice to Theory – How the Basic Concepts Appears in a Perioperative Practice’’. International Journal of Caring Sciences, Vol 6, Issue 3 (2013) : 369 www.internationaljournalofcaringsciences.org
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