Disclosure of sensitive medical information to the patients has been debated for so long.
The summaries and comparison of three articles will help identify the ethical principles and their utility in various cultures and health care settings. Disclosing medical conditions to patients is a complicated matter as in some cultures there is the concept of collectivism instead of individualism. In such scenarios, the health providers have the responsibility to identify the needs of the patient and families while honoring their cultural values. This paper will analyze different settings and the role of service providers in maintaining the ethical stance while ensuring patient safety, satisfaction and benevolence.
Summary of Articles
Citation
Title
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Truth Telling as an Element of Culturally
Competent Care at End of Life
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A Systematic Review of Advance Directives
and Advance Care Planning in Chinese People
From Eastern and Western Cultures
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Ethics Education in Nursing:
Instruction for Future Generations of
Nurses
Table1: Articles chosen to study ethical concerns related to disclosure of medical conditions
The study by Rising (2017) entails that culture of revealing the true diagnosis or prognosis of any terminal illness is assertively enforced as patient autonomy is a vital phenomenon within healthcare settings in the United States. However, the non-dominant populations such as US-Chinese and Latin Americans do not significantly follow this culture of disclosure. This study deals with the distinction among the impacts of truth telling in the Western culture as compared to non-disclosure collectivists’ culture. In the United States as well, the culture of non-disclosure or paternalism was followed, however, this trend was changed with the philosophical, ethical and social debates about patient autonomy and individualism. Nonetheless, the ethical principle and patient autonomy guidelines adopted by the healthcare organizations and accrediting bodies in USA consider the beneficence and non-maleficence as an important perspective of care delivery. It suggests that it is imperative to combine the cultural awareness with knowledge as it contributes to the cultural humility and may provide a solution for achieving the goals of effective patient care and minimizing moral distress by combining both scenarios equally; truth telling and non-disclosure.
The second article selected discusses the cultures and practices of advanced care planning and directives in the Chinese people from the Eastern and Western cultures. Studies have shown that the concept of patient autonomy and advanced care is readily experienced among Americans but the Chinese culture has certain elements that strongly disapprove of these care program principles. The advanced care planning offers patient’s preferences for taking treatment and other healthcare related decisions, and advanced directives ensure that patient’s wishes are being followed. The differences in the cultural values, beliefs and practices influence the behaviour of individuals towards health care preferences and engagements. The Chinese culture is substantially dependent on the concept of the Confucianism that enforces the virtues of love, care, humanity and social order. It follows the concept of collectivism instead of individualism. Thus, the decision making is entirely a family process. An important element of the Chinese culture is filial piety which restricts the individuals from telling truth, discussing poor prognosis and advanced care planning. The studies suggests that Chinese value the decisions and suggestions of their physicians, and questioning or voicing opinions regarding medical treatment is considered undignified. These cultural beliefs hinder the process of truth telling and having a sound communication between family, health professionals and patients themselves. However, the results of the study contemplate that advanced care planning should be implemented while giving due consideration to the cultural beliefs and practices.
The third study deals with the importance of ethics education for nurses while addressing ethical questions related to the patient and caregiver relationship. The most important questions that arise within a healthcare setting are related to truth telling, trust, informed consents and making medical decisions that ensure the patients and families welfare. Nurses are required to make ethical decisions about the clinical information, however, there are a lot of issues that arise due to the intricate patient nurse relationships, treatment preferences and other conflicts related to informed consent and truth telling. The nursing educational programs are needed to be devised such that they instil the abilities of professional identity, social justice, empathetic relations, and advocacy while considering other’s beliefs, cultures and values. The study has reported that nurses who attain ethical education or are advanced practice registered nurses, depict more confidence, strong decision making abilities and manage ethical challenges effectively. But majority of the nurses are unaware of the ethical principles within a healthcare system. It is imperative to fill in the gap in ethics education within the nursing curriculum and identify the issues and find solutions for future clinical opportunities. It is the requirement of the evolutionary healthcare system to conduct researches for the innovative methods related to ethics pedagogy.
Comparison of Articles
All these three research articles address the ethical issues within health care system, particularly about informed consent, truth telling about the poor diagnosis and prognosis, and decision making related to treatments and other clinical implications. The first study is based on assumptions and history collection by using literature review. It informed about the prevalence of truth telling incidents and the expected outcome in three different cultures i.e. United States, China and Latin American. This study compares the process of truth telling among different cultures and explains the idea by providing a detailed analysis. It also includes the ethical principles and the cultural competence model based on themes derived from the literature review. It has linked the ethical principles with cultural preferences. It has focused more on the biases and conventions that are brought from the dominant American culture and the practices in the health care system based on the principles of ethics in providing efficient patient care. The comparison with and importance of the intercultural variations shows an illustrative example of multiethnic studies. It also addresses the recommendations for the application of cultural values within healthcare for patient satisfaction while fulfilling the purpose of benevolence and effective care.
The second article is an evidence based study and uses the systematic review as research method. The specific question that it addresses was found out using the PICO chart. It deals with the different behaviors found in Chinese people living in West versus East regarding advanced care planning and advanced directives. In this study, a narrative systematic review method was applied in order to extract themes. Authors used the qualitative and quantitative research studies while clearly being focused on its inclusion and exclusion criteria. The eligibility assessment was conducted by two different authors while any discrepancies were handled by the third author. The results compilation of the study adopted a team discussion approach until a consensus was achieved. For the screening process, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used. The study represented the sample demographics and all the steps were taken to avoid any bias or miscalculation by reviewing the themes.
The third article is also a literature based study and addresses ethical questions related to nursing education and its curriculum. This study utilizes the method of addressing a question and then by a systematic literature review, finds out possible results and identifies other related concerns. The current scenario of application of ethical principles during care delivery is a serious issue for nurses as there are many cultural, moral and ethical implications. Nurses have the huge responsibility of keeping interactive relationships with the patient and their families. Thus, this study discusses different methods by which ethical education for nurses can be made efficient at multiple levels such as undergraduate, graduate, advanced trained nurses, clinical settings and medicine. It also reaches out to provide recommendations at every possible step and the future implications of ethical guidelines in the health care practices.
References
ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Hoskins, K., Grady, C., & Ulrich, C. M. (2018). Ethics education in nursing: Instruction for future generations of nurses. The Online Journal of Issues in Nursing, 23(1).
Lee, M. C., Hinderer, K. A., & Kehl, K. A. (2014). A systematic review of advance directives and advance care planning in Chinese people from Eastern and Western cultures. Journal of Hospice & Palliative Nursing, 16(2), 75–85.
Rising, M. L. (2017). Truth telling as an element of culturally competent care at end of life. Journal of Transcultural Nursing, 28(1), 48–55.
