NURSING alongside medicine has seen an enormous progress in technology and pharmacology over the past few years that has produced so many benefits for the cure and/or care of patients. Many patients' lives are saved, others are prolonged; babies are born and live with deformities or disorders that would not have been possible two decades ago. But these developments also produce many ethical dilemmas in the delivery of care.
Nursing too has changed and progressed, nurse training has developed and, while not yet providing the much needed educational experience that is envisaged in the present move towards reforming nursing education, it does now include a greater range of physical and life sciences, to be learnt in order to help the student care in a very complex environment in the hospital situation. In the community also patients are being nursed in their homes when they are acutely or chronically ill. Previously they would have stayed in hosptial longer or been admitted to hospital. Now, not only because of the economic situation but also because the patients and their relatives choose it, that care is given at home.
At the present time the students are used as part of the work
force and are often faced with being left alone to look after patients. They need to learn to care very early in their training, and they need help in answering the questions relating to that care. It is important, therefore, that they are introduced to the study of ethics, to study how nurses should behave, what is good, right and just, but they also need to study how people behave and to consider the social, cultural and organisational infb,-nces on that behaviour.
It is to be hoped that in the future students will not be part of the work force until they are qualified, but they will still be working within the clinical environment and they and their registered nurse colleagues will need to face the major ethical issues of our time.
Medicine and nursing are interdependent professions: they share a common interest in the patients and their friends' and relatives' welfare, and have a team approach to patient care; the doctor is usually the leader and is responsible for diagnosis and prescription. Nurses are playing an increasingly important role, and are taking more initiatives and more independent responsibility for the nursing care of patients. It is important, therefore, that nurses and doctors continue to work together, and have the opportunity to discuss and debate the moral and ethical issues of care in a neutral forum. The Linacre Centre is developing that forum.
The issues that confront medicine also confront nursing, albeit in a different way: the problems of abortion, of test tube babies and malformations, of patients on life support machines, all present problems and difficult decisions to those who care for them. While it is the doctor who confronts the major decision making, the nurse is there to take part in that decision making and to support the patient and the relatives. For every patient who has transplant surgery, there are many who are not selected. These need nursing care and understanding. The issue of confidentiality has become a matter of major public debate, which circulates around the need to respect confidence of patients, and the need of other professionals to be aware of information held confidentially. It also related to the information held confidentially about a patient and the patient's right to know. The care of the long-term sick and chronically disabled falls to the nurses, who in turn need help and support.
These and other issues are ones that need to be explored from an ethical viewpoint. Seminars, workshops and study days are needed to help nurses face the issues of modern day nursing and medicine. Already various events have been organised by the Linacre Centre on euthanasia and clinical practice, attitudes to human life, test tube babies, on the sanctity of life, and on the young Catholic in nursing. There has been a residential course in nursing ethics. These and other activities have been a help to some nurses. A book is in process that will help many nurses in the future.