A framework to enhance ethical practice within the nursing profession in South Africa

Abstract

Nursing ethics is the basis of nursing practices, and is aimed at improving the well-being of patients and their families, society, and the nursing profession. However, nursing ethics education and practice have always been under scrutiny globally, due to prevailing unethical practices perpetrated by some nurses. In South Africa, some of the investigations into these practices have resulted in disciplinary hearings by the South African Nursing Council (SANC). It is against this background that the aim of the study is to describe the status of nursing ethics and consequently develop a framework for enhancing ethics education and practice within the nursing profession in South Africa. Higher education institutions and the public health care services sector in Free State Province provided the study's context and reference point. A convergence mixed-methods approach was used, in terms of which relevant literature and pertinent documents were reviewed, a survey was undertaken for exploring the ethics knowledge of the Com-serves; while unstructured interviews were also conducted with ethics educators and Com-serves. Inferences from these diverse data sources portrayed the status of nursing ethics and gave insight into the trajectories that may be pursued to enhance ethics in nursing and, therefore, ethical patient care. The study results revealed that nursing ethics is constrained by factors such as misinterpretation of broad SANC directives, resulting in discordant nursing ethics and professional practice, as well as limited ethics content in education. The results further reveal poor ethical reflection amongst healthcare professionals. For instance, while the Com-serves reported unethical practices and attitudes by senior nurses and medical practitioners, they lacked the courage to report similar unethical behaviour towards iii patients. It was further revealed that there exists a narrow understanding of ethical and legal frameworks among the Com-serves. As pronounced in the conceptualisation of nursing ethics, the use of personal values was also prevalent. Therefore, the study recommends an ethical framework that considers internal and external guidance of morality as the basis for preparations in nursing ethics education to enhance the nurses’ encounter with their clients. Such a framework should recognise nursing ethics from the philosophical view of ethics as a binding responsibility focusing primarily on a patient as the vulnerable and suffering ‘other’. The framework should also integrate the application of ethical and legal frameworks in nursing activities for achieving human dignity as a normative standard described by the patient.