Expository Essay on Optimal Ethical Decisions in Nursing Practice

Introduction

Vaccinations are directly attributable to the numerous public health success across the globe. It is due to vaccines that the world successfully addressed polio and smallpox. In the United States, and globally, there are significant investments in research aimed at discovering vaccines for the treatment and prevention of the many diseases that affect communities and individuals (Hendrix, Sturm, Zimet, & Meslin, 2016). Significant gains have been recorded. Despite their successes, however, there are ethical issues attached to vaccines. Ethical issues about vaccinations relate to their development, use, and regulation, and impact negatively on nursing practice by inhibiting the level of disease prevention and treatment within communities.

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How Ethics Relates to Vaccinations

The first ethical issue regards vaccine mandates and objections. State policies within the United States demand certain immunizations and include them in school admission requirements (Dubov & Phung, 2015). Such requirements are decades old and include vaccination against smallpox, measles. The licensing and admission of vaccines to the national immunization schedule follows extensive research, examination, and analysis, the relevant federal and state bodies oversee that. However, ethical objections and debates, as well as other mandates, result from the diverse religious and philosophical backgrounds of the populations for which the vaccinations are intended. There are concerns that vaccines may infringe on the liberty and autonomy of individuals. Specific population groupings have no trust in modern safety and medical evidence and would want to preserve their ideological beliefs which are not accommodative of vaccinations.

The second ethical concern relating to vaccinations regard their research and testing (Dubov & Phung, 2015). Such concerns relate to vaccine development procedures, the study design selected for the development, the population used, and the sample location. While the development process for a vaccine is rigorous and involves many stakeholders, who are drawn from many social and scientific disciplines, there are instances where, as a result of conflicting priorities, ethical debates arise. For example, the research teams may disagree on who should be included in the vaccine trials. For proper vaccine testing, clinical trials require control groups. However, the challenge arises when there is no guaranteed prevention mechanism when the vaccine is intended to treat a life-threatening disease.

The third ethical concern relating to vaccinations regards access issues. Discussions around this issue rely on the fact that access to vaccines is dependent on racial and socioeconomic status among ethnic minorities (Gottvall, Tyden, Larsson, Stenhammar, & Hoglund, 2015). The ethical concern thus becomes whether all lives are equally valuable and deserve prevention against disease in the same measure. There have been instances of vaccine shortages. While in some cases such shortages have been permissible, such as in the case of flu vaccines which must be disposed of regularly, in some instances, the factors leading to shortages such as a shortage in several suppliers and producers are indefensible. This issue is particularly of concern because, in the event of a lack, healthcare providers have to determine who is most deserving.

Ethical Applications of Vaccination to Nursing Practice

Nurses are the custodians of vaccines as they administer vaccines to patients. Nursing practice exposes nurses to many diseases as they get in contact with patients (Gottvall et al., 2015). Some of the more common diseases include influenza. For their prevention, nurses require vaccinations to mitigate the risks of contracting such diseases. The work environment also exposes the family members of the nurse and other patients to certain infectious diseases. Nurses may unknowingly transfer a disease from one patient to another or their family members back home. This may be dangerous, especially if such patients or family members are of tender age and vulnerable. As a result, the nurse is required to be vaccinated. However, in cases where access to vaccines is limited, as noted among racial minority groups, selecting who is more deserving becomes a challenge when the healthcare environment is itself a risk factor.

Nursing practice depends on the admission of vaccinations for proper patient care. Immunizations are used for the protection of patients and communities against preventable diseases (Hendrix, Sturm, Zimet, & Meslin, 2016). Sometimes the nurse has to make decisions on behalf of the patient. This occurs in cases where the patient or the community has little understanding of the merits of vaccines, or are too illiterate to make guided consent. In some cases, due to the lack of knowledge of the importance of vaccinations, the parent may infringe on the right of the child to be vaccinated. The issue of parental rights as regards decision-making during vaccination poses an ethical challenge. The role of the nursing practitioner in the application of nursing principles is inhibited when their capacity to discharge services that bring about care to the patient is limited.

The issue of attitude towards vaccination influences the success of nursing practice as regards vaccinations (Spike & Lunstroth, 2016). While there are legal safeguards that require children to be vaccinated, such diseases as smallpox and polio, such guarantees do not extend to the regularity of vaccinations. Children are expected to be provided with prevention against disease at specific intervals as their immune systems develop. It is easy to track their progression when parents attend post-natal care. However, due to their religious beliefs, some parents do not seek hospital care after childbirth and instead choose traditional approaches to child care. In such cases, nursing practice is affected because the desire to reach every child with proper medical care and the aspiration to realize community-wide prevention against diseases that have vaccines becomes difficult.

How Professional Nurse Can Use Ethics to Improve Healthcare Related to Vaccination

The first thing that the professional nurse can do to improve healthcare-related to vaccination is to ensure accessibility to all. While there could be some communities or parts of the population that may have their reservations regarding certain vaccines, it is essential that such preventions are available to all. This way, the issue of shortages which brings about the dilemma regarding who is more deserving does not arise. The second way that nurses can apply ethics to improve healthcare as pertains to vaccination is to ensure that there are more transparency and more inclusivity in the processes that lead to the development and testing of vaccines (Hendrix, Sturm, Zimet, & Meslin, 2016). When such an inclusive approach is employed, there are better understanding, and stakeholder conflicts that delay the realization of vaccines within healthcare settings do not occur. Thirdly, professional nurses need to avoid an adversarial environment that becomes counterproductive to the immunization processes as regards attitudes. The nurse needs to understand the philosophical and religious positions of those opposed to vaccinations and to find better ways to engage them so that they are willing to be vaccinated for their good. Nurses also need to lead in the vaccination drive so that they do not expose other patients and family members to diseases they carry from patients.

Example Application of Nursing Ethics and Vaccination

Vaccinations against tuberculosis (TB) have been hard to achieve due to the underlying ethical dilemma, especially as regards HIV/AIDS patients that suffer from TB as an opportunistic disease (Doody & Noonan, 2016). The development of such vaccines becomes a challenge because of the concerns about the stigmatization associated with samples for tests leading to such medication. Ethical approaches would guarantee the protection of information, the proper engagement with the various stakeholders regarding the vaccine development process, and the realization of more directed tests.

Conclusion

Ethical issues around vaccinations relate to their development and testing. Nursing practice as regards the administration of vaccines must take into consideration philosophical and religious objections by individuals and communities. Issues around the procedures for testing vaccines raises ethical concern when the target disease is life-threatening. Consent is another one when it comes to the admission of vaccines to children. Additionally, the management of vaccines to prevent shortage which would compel the nurse to decide on who is more deserving becomes a moral and ethical issue, considering the expectation that all lives are regarded as equal.

References

Doody, O., & Noonan, M. (2016). Nursing research ethics, guidance, and application in practice. British Journal of Nursing, 25(14), 803-807. Retrieved from https://193.1.102.136/bitstream/handle/10344/5187/Doody_2016_nursing.pdf?sequence=2

Dubov, A., & Phung, C. (2015). Nudges or mandates? The ethics of mandatory flu vaccination. Vaccine, 33(22), 2530-2535. Retrieved from https://www.sciencedirect.com/science/article/pii/S0264410X15003564

Gottvall, M., Tyden, T., Larsson, M., Stenhammar, C., & Hoglund, A. T. (2015). Informed consent for HPV vaccination: a relational approach. Health Care Analysis, 23(1), 50-62. Retrieved from http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A679431&dswid=-9334

Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M. (2016). Ethics and childhood vaccination policy in the United States. American journal of public health, 106(2), 273-278. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4815604/

Spike, J. P., & Lunstroth, R. (2016). A casebook in interprofessional ethics: a succinct introduction to ethics for the health professions. Springer.