NRSG370 | Safety Issues of Nurses in the Oncology Department

For your assessment: Write 600 words on an issue of safety or of legal responsibility that you explored in some depth, ensuring it is specifically related to the specialty area. 

Module 2 

Module two looks specifically at the rights of clients and in more depth the rights of carers in the process of treatment and recovery. It raises some questions about how the nursing profession views and deals with the rights of the carers and their need for information, particularly in the context of patients/clients who may lack insight in their care needs. 

For your assessment: Write 600 words on your understanding of the dilemma of providing  information to carers while considering the confidentiality concerns relating to the patient/client. Don't forget to consider the ethical implications in your consideration of the issues. Ensure it is specifically related to the specialty area. 

Answer:

Introduction

Being into a nursing profession is quite challenging as nurses need to deal with various kinds of issues while handling the patients. Apart from that, the nursing profession also suffers with the safety issues. If the nurses are not safe in their workplace then it affects the quality of care they provide. The following paper will discuss the safety issues of nurses in the oncology department and it will also describe the ethical dilemmas associated with the profession while maintaining the confidentiality.  

Module 1

Nurses play the vital role in patients’ care as the safety of the patients is associated with the efficiency and effectiveness of the nurses. When patients visit the hospital, the prime responsibility falls on the safety and security of them. If any organization is not capable in providing a safe and secure environment to any patient then it hampers its quality services as well as the reputation (Aliyu, Adeleke & Omoniyi, 2015). If a nurse is successful in providing patients’ safety along with quality of care then that is the main reward in that profession. Patients’ safety has been an essential concern in the medical term which is always treated with highest priority.

However, safety of the nurses should equally be prioritized while providing safety to the patients.  Contamination of chemotherapy can cause serious life threatening health issues for the nurses as many studies have found that due to the long term exposure to the chemotherapy agents without having the knowledge of safety guidelines nurses suffer from serious adverse effects on health (Connor, Lawson, Polovich & McDiarmid, 2014). Unintentional exposure can affect their nervous system as well as the reproductive system.  In most of the cases due to the limited staffing nurses are more likely to face the risk of exposure to toxic drugs. The toxic drugs used as the chemotherapy agents in the treatment of cancer might be present in the vomit and urine of the patient. Nurses may need to face such situations where the patient is vomiting and in this case if the nurses are not wearing proper safety gear such gloves, cap etc. then it also might affect the health of the nurses (Lamiani, Borghi & Argentero, 2017). Nurses provide 24x7 hours of support to the patients and deal with several serious health issues too which becomes very much stressful and challenging for them and sometimes extra working hours also becomes challenging for them. Patients of Oncology department need to undergo various types of medications and some of those medications might have adverse effects on the patients’ health. Nurses’ role is very much essential in observing as well as monitoring and if any kind of adverse symptoms have been found in the patients, an immediate action must be taken in order to control that (Luz et al., 2015). Nurses also take the responsibility to inform the practitioner about the issues and in this regard they keep a clear documentation elaborating patients’ condition in detail. Sometimes, not keeping the detailed record of the patients can create massive medication error and so nurses need to be very careful (Peicius, Blazeviciene & Kaminskas, 2017).

Furthermore, in oncology department, generally nurses need to provide end-of-life care or palliative care to the patients where nurses face many deaths also (Petrova, Dewing, & Camilleri, 2016). Sometimes, patient parties act violently due to the sudden death of any patient and in such cases nurses are more likely to suffer from the violence as they directly stay in contact with the patient and their families. Nurses need to face lots of issues that hamper their safety in the workplace and the most concerning issue of them are the workplace violence (Phillips, 2016). It not only affects the physical wellbeing of the nurses rather it also affects the psychological stability. In many studies it has been found that due to the workplace violence nurses suffer from anxiety disorder and even in many cases nurses have left their profession out of fear (Purpora & Blegen, 2015).

This discussion provides a clear idea that being into a nursing profession is quite challenging and in oncology department, nurses need to be more cautious as in the treatment of cancer, toxic drugs are used which might affect their health if safety guidelines are not followed (Speroni, Fitch, Dawson, Dugan & Atherton, 2014). The safety concern is mainly the hygiene and some strategies can help a nurse in this regard. Use of N95 masks are recommended for the oncology nurses and along with that, powder free gloves, made of nitrile rubber, latex and some other safety equipments can be used by the nurses. It should be checked that the gloves are not damaged. A fibre free and disposable uniform is also recommended. To be completely safe from the exposure of the drugs used in chemotherapy, goggles, face-shields are also used for protection (Shirakawa et al., 2017). All these knowledge will help in my scope of practice and I will be more careful while providing care to the patients in future.

Module 2

Dilemmas are common part of healthcare. Nurses of Oncology department always encounter multiple kinds of dilemma whilst working with the patients and most of the dilemmas are associated with the term confidentiality (Wolf et al., 2015). The most frequently reported dilemmas by the oncology nurses are related to the truth-telling as most of the patient families want to maintain the confidentiality of the disease with the patient and they do not want to disclose the reality to the patient. In this way, nurses face problematic situations sometimes. Again, in many cases patients do not want to reveal the fact about the disease to their families and nurses need to maintain the secret to the family of the patients. In this way, it becomes challenging for the nurses to maintain the privacy (Peicius, Blazeviciene & Kaminskas, 2017).

Confidentiality is one of the important factors in nursing which is helpful in building trustworthy relationship with the patients and their families. Nurses and other healthcare professionals are bound to maintain the confidentiality of the patients. It is the right of the patient to keep the medical information private and a nurse without the consent of the patient cannot ever disclose the private information to any other person. In this regard, the wellbeing of the patient can also be jeopardized (Connor, Lawson, Polovich & McDiarmid, 2014). Arriving into the nursing profession, the first duty and responsibility of a nurse is to get concerned about the patients’ safety and confidentiality. It should be considered as the primary factor before making any professional judgement. Starting from the name to the physical as well as psychological condition of any patient cannot be disclosed without taking the consent from the patient. But, in case of oncology, as it one of the major life-threatening diseases, it might create impact on the mental wellbeing of the patient and as a consequence it can hamper the treatment procedure also (Aliyu, Adeleke & Omoniyi, 2015). Therefore, in many cases, patients’ family do not want to inform the patient about the disease and it happens mostly, when the patient is a child. In such cases, nurses face dilemma while taking care of the patient, as it is important for the nurses to build trust and honesty with the patient.

If the confidentiality of the patients’ is betrayed then they might become reluctant in cooperating with the treatment procedure in future (Luz et al., 2015). Nurses, who are involved with the end-of-life care, are more likely to experience ethical as well as legal dilemmas. In many studies it has been found that in the hospice or in the palliative care unit, nurses experience multiple types of ethical issues associated with the treatment procedure of the patient (Petrova, Dewing, & Camilleri, 2016). In order to precede the treatment procedure, nurses need to ask lot of questions to the patient regarding their health and other aspects also. Among the questions, many of them can be personal and private. Patients sometimes cannot honestly answer all the questions asked by the nurses. But, the nurses cannot use medical and personal information of the patients without their consent which in turn causes ethical dilemma (Schwappach & Gehring, 2014). The legal part associated with the oncology nurses are the rights and interests of the patients. Under the HIPAA act, which has been effective since the year 2003, without the consent of the patient, information cannot be obtained and if not followed the act, legal steps can also be taken by the patients and their families (Dalianis, 2018). Again, if the nurses cannot get an honest support from the patients, then it also hampers the treatment procedure and so it is the right of the carers to get complete information of the patients. Therefore, while maintaining the confidentiality nurses need to face ethical dilemmas. 

If the confidentiality of the patients is not maintained by the nurses then it keeps a huge impact on the services and reputation of the organization. It also hampers the relationship between the nurses and the patients. If the trust relationship is not built, then patients will not share their problems freely with the nurses which will come out as a barrier to the treatment procedure. Again, medical reports of the patient cannot be disclosed to others without the consent of the patient and under the Access to Medical Reports Act (1988), informed consent must be taken from the patients (Phillips, 2016). Therefore, in order to avoid the issues and dilemmas regarding the confidentiality of the patients, it is essential for all the nurses to get informed consent from the patients and the families of the patients before disclosing any information regarding the disease.

Conclusion

Workplace safety is concerning and nursing profession is not an exception. In oncology department, nurses face issues on safety. They also face ethical dilemmas while maintaining the confidentiality of the patient. However, some safety tools and equipments are recommended to reduce the safety concern and proper strategy to deal with the dilemmas should also be followed. This paper is helpful for nurses to acquire knowledge about the challenges of the profession.

References

Aliyu, D., Adeleke, I. T., & Omoniyi, S. O. (2015). Knowledge, attitude and practice of nursing ethics and law among nurses at Federal Medical Centre, Bida. American Journal of Health Research, 3(1-1), 32-37.

Connor, T. H., Lawson, C. C., Polovich, M., & McDiarmid, M. A. (2014). Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence. Journal of occupational and environmental medicine/American College of Occupational and Environmental Medicine, 56(9), 901.

Dalianis, H. (2018). Ethics and Privacy of Patient Records for Clinical Text Mining Research. In Clinical Text Mining (pp. 97-108). Springer, Cham. Retrieved from https://link.springer.com/content/pdf/10.1007%2F978-3-319-78503-5.pdf 

Lamiani, G., Borghi, L., & Argentero, P. (2017). When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. Journal of Health Psychology, 22(1), 51-67.

Luz, K. R. D., Vargas, M. A. D. O., Schmidtt, P. H., Barlem, E. L. D., Tomaschewski-Barlem, J. G., & Rosa, L. M. D. (2015). Ethical problems experienced by oncology nurses. Revista latino-americana de enfermagem, 23(6), 1187-1194.

Peicius, E., Blazeviciene, A., & Kaminskas, R. (2017). Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals. BMC medical ethics, 18(1), 40.

Petrova, E., Dewing, J., & Camilleri, M. (2016). Confidentiality in participatory research: Challenges from one study. Nursing Ethics, 23(4), 442-454.

Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England journal of medicine, 374(17), 1661-1669.

Purpora, C., & Blegen, M. A. (2015). Job satisfaction and horizontal violence in hospital staff registered nurses: the mediating role of peer relationships. Journal of clinical nursing, 24(15-16), 2286-2294.

Schwappach, D. L. B., & Gehring, K. (2014). ‘Saying it without words’: a qualitative study of oncology staff's experiences with speaking up about safety concerns. BMJ open, 4(5), e004740.

Shirakawa, T., Hara, T., Hata, K., Hata, K., Suetsugu, K., Kakimoto, H., ... & Fukahori, M. (2017). Analysis of a Questionnaire Survey regarding Current Conditions against Exposure to Anticancer Drugs and Reports of Cancer Chemotherapy at Outpatient Departments in Japan. Pharmacology & Pharmacy, 8(05), 140.

Speroni, K. G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2014). Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of emergency nursing, 40(3), 218-228.

Wolf, L. E., Patel, M. J., Tarver, B. A. W., Austin, J. L., Dame, L. A., & Beskow, L. M. (2015). Certificates of confidentiality: Protecting human subject research data in law and practice. The Journal of Law, Medicine & Ethics, 43(3), 594-609.