BACHELOR IN NUSING SCIENCES

SEMESTER 5 / SEPTEMBER 2022

NBNS1313

PERIOPERATIVE NURSING

MATRICULATION NO : 830118016044001
IDENTITY CARD NO. : 830118016044
TELEPHONE NO. : 0142745884
E-MAIL : arrieyati@oum.edu.my
LEARNING CENTRE : PETALING JAYA LEARNING CENTRE
Contents
1. INTRODUCTION....................................................................................................................1

2. ETHICAL DILLEMAS IN PERIOPERATIVE NURSING PRACTICES.............................3

2.1 Informed Consent.................................................................................................................3

2.2 Patient Privacy and autonomy..............................................................................................4

2.3 Inadequate resource and staffing..........................................................................................4

2.4 Advance care planning.........................................................................................................5

2.5 Performing incorrect surgery................................................................................................6

3. NURSES BENEFITS OF EMPOWERMENT ON ETHICAL KNOWLEDGE.....................7

4. CONCLUSION......................................................................................................................10

5. ONLINE CLASS PARTICIPATION....................................................................................12

6. REFERENCE.........................................................................................................................15
 1. INTRODUCTION

According to Cambridge Dictionary, ethic are define as a system accepted belief that controls
behaviour especially such a system based on morals. It is also a study of what is morally right
and what is not. Ethics are not an absolute law but they represent the attitudes and values in the
society. There is degree of discretion as one can choose to follows as ethics serve as a moral
guideline. Ethics maybe differ from one place to other depending on the area of practice.

Although law is not bind by the ethical standards, due to its social acceptance, there become
more formidable. The term “unethical” refers to behaviour that is at odd with the standards and
value that are currently in place. Because it draws the attention to the flaws in legislation, ethics
acts as guide for it. The line separating moral and unethical behaviour are not well defined and it
makes the practitioner having a tough time in making choices.

In the emerging world, patient journey are improving in efficiency and cost effective as nursing
practices is developing. Due to recent advancement in technology and medicine as well as
greater emphasis on standardization and the logic of production that permeates contemporary
hospital cultures, hospital environment has become more complicated. This implies that in
addition to attend the need of the patient and the care giver or families, nurses often have to deal
with numerous demands from other medical staff and also hospital administration. The holistic
approach that is the hallmark of nursing entails an ethical responsibility to uphold and respect the
person integrity and dignity. As a results, nurses have to infused with both moral and ethical
consideration on top of the law that were to bind with.

Operating room are one of the clinical area that is highly technical setting area where the focus
are on both surgical and other invasive treatment as well as focusing on the patient safety and
care. Due to the nature of the works, operating theatre nurses must be able to uphold the
professionalism that built on both compassion and ethics.

Perioperative nurses have to be ready to act in accordance with the specified ethical code as they
do make an ethical decision on regular basis. In ensuring the patients’ rights, health and safety,

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they must also take into consideration the value of autonomy, justice, beneficence,
nonmaleficense, faithfulness and honesty. American Nurses Association state that privacy,
secrecy, research involvement and practice requirement are also covered in their provision in
order to ensure patient advocacy. It is essential that patient advocacy to be practiced among the
perioperative nurses as the patient condition are affecting their decision-making capacity.
In every stage and setting of perioperative nursing practice, ethical concerns may arise. Both
patient and the perioperative nurse can be benefitted from being aware of typical problems and
having a basic comprehension of a model that can be used to examine and to resolve the issue.
The nurses can advocate who are aware of and take an action to address current and foreseeable
ethical concern that will helps the patients.

When the nurses are given the knowledge and moral abilities to promote autonomy, to safeguard
privacy and confidentiality and to defend human rights, everyone will wins. Perioperative nurses
should think back on the past ethical issue and apply them to help in resolving the current ethical
issue that arising. When face with moral quandaries, they should be aware of the professional,
departmental, institutional and personal resource accessible to them.

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 2. ETHICAL DILLEMAS IN PERIOPERATIVE NURSING PRACTICES

In the high-tech, demanding environment of the operating room, patients are subjected to
invasive procedures. Interpersonal disputes are common in operating rooms since many different
healthcare workers conduct overlapping tasks there. In this setting, life-threatening
circumstances and occurrences needing quick decisions frequently occur. Operating room nurses
face ethical difficulties as a result of these traits. Complex problems that are difficult to resolve
are ethical difficulties.

In caring for postoperative patients in real time setting, perioperative nurse frequently finds it
difficult in making moral choices. Although its challenging but it is necessary and important at
the same time. Perioperative nurses must be able to identify moral conundrums and respond
appropriately when necessary. They are accountable for making clinical and technical nursing
decision that are also morally appropriate and suited for the particular difficulties of the patient
being treated.

What can be done for the patient is answered by the technical or medical facets of nursing
practice. What should be done for the patient is addresses in the moral competent which also
covers the patient’s wishes.

The most frequent ethical issues in operating theatres are: respecting patient privacy and
autonomy, inadequate staffing, failing to adhere to sterility rules, performing the incorrect
surgery and failing to get informed consent. (Aghamohammadi et al., 2021)

2.1 Informed Consent

The issue of informed consent for nurses may raise an ethical issue occasionally. This issue
arises when the patient and their families have not been told or do not comprehend the treatments
employed on the patient, a quandary might arise. In certain cases, patient may not feel
comfortable asking questions or giving consent because they do not completely understand the
ramifications of their treatment.

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The nurses responsibility while dealing with informed consent is to confirmed that the patient
has received the information and has complete understanding of the surgical procedure. As art of
the patient evaluation, the nurse determines whether the patient has any additional queries that
may necessitate another conversation with the doctor. Sometimes, the nurses are asked to
obtained the patient signature on the consent form. Nurses need to understand that the are not
eligible for the said process and they can only serve as witness in the said situation

2.2 Patient Privacy and autonomy

Due to the loss of their regular privacy and the fact that they are asleep, patient in the operating
room are indirectly exposed. As a results, all healthcare worker are extremely concern about
protecting the patient privacy. Concern over the patient confidentiality and privacy are serious
ethical issue. If neglected, it can cause a legal repercussion and have negative impact on the
hospital. There are clear limits and procedures for preserving patient privacy since the Health
Insurance portability and Accountability Act (HIPA) protects medical information about
individuals.

Nurses must respect patient autonomy while upholding the patient rights and act in their best
interest. All healthcare personnel should respect patient autonomy which is the freedom in
making decision relate to their care based on their personal or cultural belief system. Patient have
the choice to reject treatment, drugs or surgical procedure. As long as it is in the patient best
interest, the healthcare personnel should respect the patient choice either related to surgery and
anaesthesia.

2.3 Inadequate resource and staffing

The surgical team consist of many professional with distinct responsibility who collaborate to
accomplish a shared objectives, comprehend the complexity of the clinical situation, make wise
judgement and carry out safe operation. The effectiveness of these individuals directly affects the
results of the surgical team. Although its not a moral dilemma for nurses, hospital administrator

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need to be aware that inadequate staffing can affect the patient care and outcome. The patient
acre may be jeopardize when the medical facilities are short on resources that force the staff to
make challenging choices. Due to the constraint and stress overload, nurses moral duties to
patient are jeopardized on top of that they have to battle mentally to determine where to put the
priorities.
Failing to adhere of aseptic technique.

With the experience from the operating room nurses, surgical site infection is a significant
postoperative complication that can occasionally led to patients being sent back to operating
room for second surgery or long-term hospitalization. By doing and adhering to the concepts of
aseptic and sterile technique, addressing to proper hand washing, through cleaning and
sterilization of surgical instrument, proper skin preparation and placement of drape, the operating
room nurses can play a significant role in preventing and controlling the issue. Ensure that the
temperature and humidity of the operating room is within the set criteria. Control of temperature
and humidity may helps in reducing the bacterial activity within the sterile vicinity. Schedule
cleaning and changing of Hepa filters and periodic monitoring of air quality is also essential in
order to set the bench mark of safe operating theatre.

2.4 Advance care planning

Advance decision are legally binding expression of a person wishes regarding their end of life
care including which treatments they wish to accept or decline such as being put on ventilator
support or receiving cardiopulmonary resuscitation, under Mental Capacity Act 2005 (Care
Quality Commission,2017). These discussion take place between patient and doctors when they
need to make an arrangements for their future medical care in the events that they pass away or
become to ill to do it on their own. They are able to define their own belief and goals about their
potential medical care approach. Patient have the right to nominate the next of kin that will make
the decision for them in the future. The challenge is to ensure that these preference are stated and
respected in medical emergency typically falls to nurses. Issue may arises when the patient wish
are contradict with the family member wishes. Despite the challenging scenario, nurses must
prioritize and respect the patient wish particularly in end of life care. (Themes, 2021)

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 2.5 Performing incorrect surgery

It is the entire team responsibility in ensuring that the procedure performed in the safest manner
feasible once the consent obtained, fulfilled and documented. Local protocol as well as national
and international initiatives serve as our guidelines in this. The second global patient safety
challenges following the first that focused on healthcare associated infections was Safe Surgery
Saves Lives (WHO, 2008). Four areas where patient safety might be dramatically improved were
agreed by WHO through World Alliance on Patient Safety Working Group. 10 key goals were
establish and operating on the right patient, right side and site are the top of the goals as to
reduce surgical complication along with others.

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 3. NURSES BENEFITS OF EMPOWERMENT ON ETHICAL KNOWLEDGE

Nurses must be able to identify and handle ethical dilemmas as they occur given the complexity
of today healthcare system. The first step in oral action is ethical awareness which involves
acknowledging the ethical consequences of every nursing action. This means that in order to
effectively handle issue and meet the patient requirements, nurses must first be aware of any
potential ethical consequences of their activities.

Dealing with ethical dilemma for nurses can be devastated. The nurses are frequently asked on
the medical procedures and how to handle the conundrums. Most of the times, they need to make
the call on the spot. With patient interactions and years of experience gained, eventually the
nurses will be able to handle the situation. High level of empathy are common among the nurses
which enables them to establish professional boundaries around their patient care and have
honest interactions with the patients.

Nursing empowerment and encouragement are fostered in healthy work setting which are
evidence of the high calibre of care provided to patients. It will take moral bravery and
dedication on the part of nursing leadership to successfully complete the challenging work of
finding the secrets to excellence. This calls for nurse leaders to set an example for their nursing
team by exhibiting moral courage and problem-solving techniques. Avoiding issue and
dysfunctional system can only make the nurses more frustrated and disappointed.

The need of emphasizing patient rights is seen as crucial especially when a patient frailty makes
him susceptible to the flaws and breaches of the healthcare system. This preserves the patient’s
dignity as a rank of human. In a hospital, respecting patient’s rights is the most crucial ethical
concern that must be taken into consideration. Medical professionals have to pay close attention
to all its facets. Respecting patients right entails holding all medical personnel responsible for
them during treatment and care.

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In clinical practice, maintaining patient privacy is crucial because it shows patients that we
respect and motivates them to disclose the personal information needed to provide high quality
medical care. Information confidentiality is primarily based on the idea of respecting autonomy
as an ethical concern. Its relates to physical characteristic of the person and any relevant
extension of information. Therefore, respecting patient’s decision including such information is a
duty of professional under and raise awareness among healthcare worker about patient rights,
legal obligation of patients and healthcare provider and communication skills in order to defend
and implement patients’ rights. Thus it will be feasible to address associated issue, enhance the
standard of healthcare, deliver services that are respectful of human dignity and prevent the
violation of the patient rights. (Dermisoy & Kirimlioglu, 2016)

A proactive action like this is referred as “moral agency”. Nurses are alert to the potential ethical
dilemma and takes action to address the issue. To exemplify this attitude in practice,
understanding that it is our duty as profession to act as agent on behalf of patient in addition to
being willing and able to take action. By accepting one's moral agent role in this way, a nurse
may be better able to bounce back from difficult clinical situations that may be upsetting and
gain new skills. So, the first step toward a lasting, ideal ethical behaviour is ethical
consciousness.

In similar vein, nurses that empower with sufficient authority will feel more confident to carry
out their duty and deliver higher standards of patient care within their own unit. The purpose od
the unit manager in this situation is to promote the conditions necessary for nurses to be
empowered to provide the greatest care for the patients. It also demonstrates that psychological
empowerment which encompassed a sense of purpose, self-determination, competence and
impact had the potential to play a significant role in professional development, increase nurses
job satisfaction and improve patient care. Employee that aware of their sense of self-worth,
purpose and morale will be more independent, accountable and involved. It also will expand
their professional reputation and continuously enhancing the healthcare system.

According to study done by Manojlovich and Laschinger and Faulkner, empowered nurses use
organizational and nursing unit domains more effectively which increase job satisfaction. As a

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results, Laschinger et al. established that strong relationship between nurses and the unit manager
in particular will facilitate the nurses sense of empowerment. The demand of the patient and their
families may be met and empowered nurses can successfully advance their careers and the
objective of their organization.

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 4. CONCLUSION

The integrity of the nursing profession depends on ethics since it helps to provide better patient
care. There are new issues in nursing everyday and the managers all over the country face
comparable moral conundrums. Nursing is a fast-paced profession. The protection of patients’
rights, having enough staff, making informed decision and providing high quality patient care are
at the heart of many of these circumstances. Unfortunately, given the increase number of new
nurses joining the field, many of them lack of the necessary experience to handle ethical
dilemmas in nursing. To solve these issue, the healthcare team really needs well season nurse
managers.

As mean of protecting, communicating, valuing, mediating and promoting social justice in the
delivery of healthcare, patient advocacy, a qualified healthcare worker is needed for the complex
process of advocating for vulnerable patients. However, it can be detrimental consequences
including conflicts with the other and may being marked as troublemaker, whistle blower or even
a bad co-worker. It may leave one feeling alone and frustrated, experiencing moral distress or
dilemmas and having to fight with the leaders, receiving verbal or written reprimands and worse,
can lead to loss of job, reputation and professional status.

Within the fold of patient, during the they are fragile and exposed, patient need someone to make
decision on their behalf when they are their lowest point. Patient care could suffer, clinical
relationship could become strained and the nurses could experience moral discomfort if they do
not effectively address the ethical issues. Nurse managers could be under pressure when it comes
into ethical dilemmas since they are the ones that he nurses turn to for guidance and direction
during these difficult situations.

It is proposed that guidelines and framework may be created under the supervision of ethics
expert or committee to enhance the ethical and professional performance of operating room
nurses by the implementation of these rules.

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It is not an easy process that calls for qualified nurses, guidelines and understanding management
to advocate the vulnerable patients. The study of this idea can aid in the creation of management
or educational ideas as well as the creation of tools for measuring nurses efficacy. Improve the
safety and calibre of nursing care in the community and healthcare system. Developing the
strategies in strengthening patient advocacy. Together, the hospital officials must ensure that all
morally righteous decisions are made in the best interest of the patients while respecting the
patient choices.

Word Count : 2833 words

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5. ONLINE CLASS PARTICIPATION

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6. REFERENCE

1. Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2019). Patient advocacy in nursing: A
concept analysis. Nursing Ethics, 27(1), 141-
151. https://doi.org/10.1177/0969733019832950
2. Aghamohammadi, F., Imani, B., & Moghadari Koosha, M. (2021). Operating room
nurses’ lived experiences of ethical codes: A phenomenological study in
Iran. International Journal of Nursing Sciences, 8(3), 332-
338. https://doi.org/10.1016/j.ijnss.2021.05.012
3. Demirsoy, N., & Kirimlioglu, N. (2016). Protection of privacy and confidentiality as a
patient right: Physicians’ and nurses’ viewpoints. Biomedical Research, 27(4), 1437-
1448. file:///C:/Users/user/Downloads/ProtectionofPrivacyandConfidentialityAsAPatient
Right.pdf
4. Schroeter, K. (2002). Ethics in perioperative practice-patient advocacy. AORN
Journal, 75(5), 941-949. https://doi.org/10.1016/s0001-2092(06)61458-0
5. Themes, U. (2021, December 2). Legal and ethical implications in the perioperative
area. Thoracic Key. https://thoracickey.com/legal-and-ethical-implications-in-the-
perioperative-area/

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