Running head: AN ETHICAL PERSPECTIVE

An Ethical Perspective on Increasing the Nurses Responsibility in Patient Discharges

Bobbie Chahal
California State University, Stanislaus
December 5, 2013

An Ethical Perspective on Increasing the Nurses Responsibility in Patient Discharges

Nurses are significant members of a patients health care team. Nurses are expected to
meet all nursing standards of care as nurses are one of the most involved care givers. Whenever
there is an unmet need in the patients care, nurses are often the first ones that are looked upon to
address those needs. As a result, there is a lot of debate on expanding the role of nurses in
healthcare. Gaps in the Discharge Process for Patients with an Ostomy: An Ethical Perspective,
an article written by Cynthia A. Walker and Vicki D. Lachman, presents the issue of gaps in the
discharge process that are proving to be detrimental to patients. The authors argue that nurses
should be the ones to provide more thorough discharges in order to help ease the problems the
patients with the new ostomies face (Lachman & Walker, 2013). The opposition against the
authors comes from an argument that mirrors the egoism theory. This opposition believes that the
proposed action will not be in the nurses best interests. Lastly, Bentham, proposes that there are

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too many negative consequences for the nurses in comparison to the positive consequences for
the patient if nurses were forced to comply with the proposed expanded role in the discharges.
Compared to the authors argument, the oppositions argument, and Benthams argument,
Benthams response deals the best with the issue of making nurses accountable for performing
more thorough discharges.
The authors of the article, Gaps in the Discharge Process for Patients with an Ostomy: An
Ethical Perspective, propose that nurses are ethically responsible for providing patient teaching,
assessing patient adaptation, and checking for the caregivers support at home for new ostomy
patients. They argue that too many new ostomy (surgically constructed opening in the body
created for the discharge of body wastes) patients are poorly discharged and are experiencing
psychological issues, mobility and lifestyle adaptation problems, lack of caregivers support once
home, and the need for more education on maintenance of the change in the body (Lachman &
Walker, 2013). The authors believe that these problems can be controlled and screened if nurses
increased their involvement in making the discharges more thorough and less rushed (Lachman
& Walker, 2013). Patients, primary nurses, and Wound, Ostomy, and Continence Nurses
(WOCN) are involved in this issue (Lachman & Walker, 2013). The article directs the attention
specifically on these nurses as being the participants of this problem in healthcare and having
ethical responsibilities to uphold even when discharging patients (Lachman & Walker, 2013).
The nurses have ethical concerns in maintaining the Code of Ethics for Nurses as outlined in
(American Nurses Association [ANA], 2001) and the Joint Commission (Foglia, Fox, Chanko, &
Bottrell, 2012) also covers ethical concerns related to the nurses ethical accountability in
situations related to specific care concerns (Lachman & Walker, 2013).
The article espouses W.D. Rosss code of ethics (Shaw and Barry: Prima Facie Principles,
p.53-56). The authors and Ross share similar views on what moral duties a person should have to

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be considered righteous. Ross is a firm believer in humans having moral obligations to follow
throughout life (Shaw and Barry: Prima Facie Principles, p.53-56). These obligations can be
complex because in certain situations, a person might be under more than just one moral
obligations. As a result, Rosss ways of dealing with morality will result in having to consider
which obligation is more important to uphold and what kind of circumstances the person is
dealing with (Shaw and Barry: Prima Facie Principles, p.53-56). These moral obligations are
called prima facie obligations and the phrase means that the moral obligation is one that can be
overridden by a more important obligation (Shaw and Barry: Prima Facie Principles, p.53-56).
Ross organized the prima facie obligations as: duties of fidelity, duties of reparation, duties of
gratitude, duties of justice, duties of beneficence, duties of self-improvement, and duties not to
injure others (Shaw and Barry: Prima Facie Principles, p.53-56). The authors follow Rosss way
of thinking because they list moral obligations nurses have towards their patients as reasons for
why nurses should step up and provide thorough discharges. The authors state that Certified
WOCNs serve the role of coordinating care, advocating for the patient, collaborating as team
members, utilizing evidence-based practice, and also serve the role of teachers to their patients
and staff (Lachman & Walker, 2013). These are examples of obligations nurses have towards
patients based on their professional titles duties. The authors begin to describe all of the ethical
violations that occur when nurses fail to deliver thorough discharges to the new ostomy patients
(Lachman & Walker, 2013). Patient autonomy is violated if there is not enough teaching
performed at the time of discharge (Lachman & Walker, 2013). If nurses do not support patient
safety by following up on the home care upon discharge, they are decreasing patient safety which
is a violation of the duty of non-maleficence (Lachman & Walker, 2013). The promotion of
human dignity is sacrificed when nurses fail to assess their patients level of coping and when

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they fail to document and communicate what their patients are struggling with (Lachman &
Walker, 2013). The lack of support immediately after having an ostomy increases the risk of
patients experiencing depression and anxiety (Lachman & Walker, 2013).
The opposition against the authors proposal to increase the nurses responsibilities would
argue that simply adding on to the nurses workload does not meet the nurses best interests
(Chahal, personal communication, December 3, 2013). From the perspective of the
administration, making nurses take on extra responsibility would eliminate a task off of the
administrations list, making the administrations job much easier (Chahal, personal
communication, December 3, 2013). However, since nurses are the ones actually carrying out the
task, their interests should be taken into consideration over those people in administration who
are merely assigning the task (Chahal, personal communication, December 3, 2013). This
opposition would agree that having more thorough discharges would benefit patients, but at the
cost of taking the quality of care away from the patients that are not ready to be discharged and
also at the cost of burning out the nurses (Chahal, personal communication, December 3, 2013).
This opposition would support the idea of offering an increase in salary to the nurses for this
increased expectation from them (Chahal, personal communication, December 3, 2013). Giving
a perk to the nurses would result in their being a benefit for the nurses in the long term (Chahal,
personal communication, December 3, 2013). Lastly, if the person being forced to do extra is
given perks, he or she will also be more dedicated and willing to comply with the new
expectation (Chahal, personal communication, December 3, 2013).
Egoism is the theory that goes hand in hand with the oppositions argument (Shaw and Barry:
Egoism, p.53-56). Based on the egoist perspective, self-interests decide what action is the correct
action to take (Shaw and Barry: Egoism, p.53-56). If the administration does plan on increasing

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expectations of the nurses, then the administration should also be ready to exchange this service
from the nurses with a benefit.
Jeremy Bentham, upon analyzing the proposal by the authors, would disagree with the
authors being adamant about having nurses be responsible for fulfilling the gaps in the discharge
process (Shaw and Barry: Utilitarianism, p. 56-58). Bentham comes from a school of thought
called Utilitarianism (Shaw and Barry: Utilitarianism, p. 56-58). This theory focuses on
choosing the act that will bring about the most positive consequences for all of the people who
will be affected by the act (Shaw and Barry: Utilitarianism, p. 56-58). Bentham would look at
both the patients side and the nurses side (Shaw and Barry: Utilitarianism, p. 56-58). He would
not support any argument that forces one party to perform an act that fulfills obligations no
matter what career the party was associated with (Shaw and Barry: Utilitarianism, p. 56-58). In
other words, Bentham would analyze the consequences of the action rather than quantifying the
action as necessary simply because it is what the person is required to do (Shaw and Barry:
Utilitarianism, p. 56-58). The patient will benefit in better health if nurses stepped up to make the
discharge process more thorough in teaching, screening for coping capabilities, and the presence
of a caretaker post discharge. The patient would have a more positive evaluation of the hospital
as a whole. The nurses would have to spend more time on the discharge process. Spending more
time will take away time from patients who are not ready for discharge and who need more care
and observation. The nurses would be more burnt out because of the increased demands from
their employers. Even though the nurses would be better maintaining their ethical obligations
related to their profession, they would be forced to do this. Being forced to do extra tasks without
any input from the nurses is a negative consequence for the nurses. Benthams conclusion: While
it is good for the patient, there are too many negative consequences for the nurses if nurses were
to be held responsible for making the discharge process more thorough (Shaw and Barry:

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Utilitarianism, p. 56-58). Either an alternative person should be hired for this process or there
needs to be more of a sharing of this discharge load throughout the care team because this would
be too debilitating for the nurses to handle alone.
Benthams responses work best with this issue (Shaw and Barry: Utilitarianism, p. 56-58).
Bentham comes from the school of thought referred to as Utilitarianism (Shaw and Barry:
Utilitarianism, p. 56-58). Utilitarianism weighs the positive and negative consequences of each
possible action to determine which action will bring about the most positive outcomes for
everyone that is going to get affected by the action that is taken (Shaw and Barry: Utilitarianism,
p. 56-58). This theory uses happiness or positive consequences to evaluate the most correct
action (Shaw and Barry: Utilitarianism, p. 56-58). The less negative consequences an act has, it
becomes the more correct choice based on the Utilitarian viewpoint (Shaw and Barry:
Utilitarianism, p. 56-58). It is unfair to drop a huge responsibility on a professional for the sake
of obligations. It would be realistic and understandable to have a volunteer or an entrepreneur
take up responsibility for doing certain tasks in the society for the sake of moral values.
However, as paid professionals, it is unfair for nurses to take on added workloads without a
stronger argument. Utilitarianism breaks down the authors argument because it allows for an
argument based on consequences resulting from an action otherwise supported by the authors
with only obligations (Shaw and Barry: Utilitarianism, p. 56-58). How can a whole
professions workload be increased without any consideration of the impact it would have on the
quality of services the professionals can provide? Benthams response is the more fair and
realistic approach to this issue. Benthams proposal of there being an alternative staff member
hired specifically for this job or there being a division of the discharge process workload works
best because it makes room for the otherwise forced piling on of work. Benthams solution
allows for a hospital unit to adjust to meet the increasing needs of the patient rather than force

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only one professional from the patients care team to take on a new challenge alone (Shaw and
Barry: Utilitarianism, p. 56-58). The egoism-based opposition is not the best solution because it
is selfish and can lead to nurses basing all of their actions based upon benefits (Shaw and Barry:
Egoism, p.53-56). Although any career should have benefits, sometimes, for the good of the field
or for the fulfillment of the careers objectives, benefits are not always plausible. The prima
facie-based argument is also not the best because it prioritizes obligations or duties above
benefits and consequences and if this is the view taken then other patients will lose out on the
time and care from the nurses if the nurses are forced to give more time in the discharges as the
authors propose (Shaw and Barry: Prima Facie Principles, p.53-56). Any action cannot be chosen
only because of what duties it fulfills, but the consequences of those actions should also be taken
into consideration to see how the act will affect everyone affected.

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References
(Bobbie Chahal, personal communication, December 3, 2013)
Lachman, V., & Walker, C. (2013). Gaps in the Discharge Process for Patients with an Ostomy:
An Ethical Perspective. Medsurg Nursing: Official Journal of the Academy of Medical
Surgical Nurses, 22 (1), 61-64.
Shaw and Barry. Normative Theories of Ethics: Egoism. Class Packet. (p.53-56).
Shaw and Barry. Normative Theories of Ethics: Prima Facie Principles. Class Packet. (p.66-67).
Shaw and Barry. Normative Theories of Ethics: Utilitarianism. Class Packet. (p.56-58).