Role of Theoretical and Ethical Basis in Enhancing the Quality of Advanced Nursing

Introduction

Theoretical and ethical considerations play a significant role in enhancing the quality of advanced nursing practice. It is therefore essential to set a particular theoretical and ethical framework that ids in guiding the medical practitioners while handling various medical conditions among their patients. In administering a theoretical framework, the healthcare agencies design a particular nursing theory that acts as a guide or a reference point while undertaking the nursing practice within the entire organization (Zborowsky, 2014). This helps to strike a balance between the philosophical assumptions of the organization and the benefits of the theory to the patients. In addition to the theoretical framework, an ethical framework focuses on providing the key guidelines that help medical practitioners to decide the most effective and the least effective (wring or wrong) actions while performing their day to day tasks. This is vital as it helps to create an ethical environment not only within the healthcare facility but also within the entire society with the aim of providing quality healthcare to the patients (American Sociological Association, 2019). While both the ethical and theoretical issues are significant in all areas of advanced nursing practices, the paper will focus on discussing its application in the pharmacologic vs. non-pharmacologic treatment of adults with major depressive disorder (MDD).

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Pharmacologic and Non-Pharmacologic Treatment of MDD

Major depressive disorder (MDD) refers to the occurrence of a depressive mood and the loss of pleasure and interest within a patient (Holvast, Massoudi, Oude Voshaar & Verhaak, 2017). It is usually accompanied by other onset symptoms such as loss of weight, fatigue, loss of weight, lack of energy, recurrent suicidal thoughts, insomnia and sometimes hypersomnia, feeling guilty most of the times, and feeling worthless. The study by Holvast, et al., (2017), shows MDD that affects approximately 16% of the adults in the United States at one point in life. It is considered as the primary cause of the most case of disability, absence from work, and distress which accounts for over 8 million cases of hospital visits per annum. Further, the study shows that while 8% of the population tests positive for MDD only 25% of them receive treatment. In most cases, patients suffering from depression receive care from primary care physicians instead of psychiatrists (Holvast, et al., 2017). In this case, it is essential that these primary care physicians are aware of the most effective evidence-based practices that can aid in treating depression. It includes grasping the relative efficacy of the theoretical and ethical framework in the nursing practice to enhance effectiveness.

The treatment of MDD appears to be as complex and diverse as the condition itself. It encompasses both the pharmacologic and non- pharmacologic treatment methods depending on the severity of the condition. Pharmacologic may include the use of second-generation antidepressants (SGAs) which is applicable when the condition is very severe and has persisted for a long period. While this treatment is beneficial, it has different side effects including nausea, reduction in sexual ability, diarrhea, constipation, insomnia, headaches, fatigue, and dizziness (Holvast, et al., 2017). Non- pharmacologic treatment methods are often effective in handling patients with the mild and moderate condition of MDD. These major method used in non- pharmacologic treatment is Cognitive behavioral therapy (CBT). In this method, the medical practitioners operate under the assumption that human cognitive functioning influences their behavioral patterns. Therefore, monitoring and changing the cognitive functions to streamline the behaviors to particular desirable patterns is achievable. However, Holvast, et al., (2017), connotes that CBT has limited efficacy in treating MDD and therefore should be supplemented with other psychotherapy methods and sometimes pharmacology options.

Theoretical Basis

The scientific phenomenon of the condition and treatment of MDD is complex and therefore requires guidance from the grand and middle grand nursing theorists. An understanding of these theories can therefore help in developing a theoretical framework that can help in determining the most effective treatment methods for patients suffering from MDD. Looking at the advanced nursing practice, it is evident that the four meta-paradigms of nursing prevail. They include a person, environment, health, and nursing (Sher & Akhtar, 2018). The meta-paradigm of person focuses on the personal attributes of the specific patient that requires nursing care. It covers aspect such as spiritual beliefs, cultural practices, socioeconomic status, and the relations among family and friends. The meta-paradigm of environment focuses on both the internal and external surroundings that affect the patient. It includes interactions with family, friends, and other people in society. The meta-paradigm of health refers to the quality and health well-being of the patient. This also covers the ability to access health care services when the need arises. Lastly, the meta-paradigm of nursing refers to the level of proficiency and competence through which nursing practitioners apply their skills and knowledge while handling and caring for patients (Sher & Akhtar, 2018). In handling patients with MDD while using either the pharmacologic or the non-pharmacologic treatment methods, nurses and other primary caregivers need to understand these four meta-paradigms to ensure that they provide high quality care to the patients.

Florence Nightingale is a nursing theorist who developed the environmental theory with the aim of understanding how the environment affects the health well-being of the patient (Zborowsky, 2014). The theory is applicable in the case scenario since environmental aspects play a vital role in causing depressive outcomes in a person (Hegge, 2013). While Florence focused on the environment meta-paradigm, the other three meta-paradigms are also evident in theory. In the theory, Florence stressed that the patient's environment is fundamental in dictating their well-being and response to treatment options (Zborowsky, 2014). Nurses have the mandate to alter the patients' environment to ensure that the recovery process is optimal and effective. The common recommended environmental conditions outlined in theory include clean water, clean rooms and bedding, optimum temperatures, free from noisy areas, enough sleep, and offering specific dietary guidelines. Nurses are also required to be positive while addressing patients but avoid providing false hopes especially when they are in critical conditions (Hegge, 2013). While this theory was developed many years ago, these guidelines apply to date. Therefore, in determining which treatment methods for MDD are effective whether pharmacologic or non-pharmacologic, the nurses should account for the environmental factors and other three met paradigms to enhance effectiveness.

Ethical Basis

Ethical principles are acknowledged as vital features of an effective advanced care nursing practice (American Sociological Association, 2019). Nursing practitioners providing care for adults with MDD need to follow particular ethical principles to ensure that they provide quality healthcare to these patients. However, outlining the definite components of ethical basis that need to be utilized to handle a particular medical condition is complex, and therefore a standard guide is applicable in all nursing practices. It is worth noting that in making decisions in nursing practice especially while selecting the most suitable treatment method, nurses need to integrate the ethical considerations. It thus means an ethical nursing practice is determined by moral actions in the context of the duties and responsibilities of the nursing practitioners. While ethical actions focus on knowing the right and moral actions to undertake, it also refers to the preparedness of putting the ethical considerations in actions. This, therefore, puts the complexities of ethical reasoning in advanced nursing practice into the limelight.

Handling patients suffering depressive condition can be complex creating various ethical dilemmas. The nursing framework, therefore, encompasses the following guidelines (American Sociological Association, 2019); Nurses need to be compassionate and show respect to the inherent dignity and personal attributes of the patients. Nurses should show full commitment to the patients whether as an individual or a group. Nurses have the obligation and accountability to make decisions and take actions that are consistent with promoting the health well-being of the patients. It is supported by providing optimum patient care through exhibiting high levels of competence, integrity, and confidence. While nurses are required to refrain from sharing the patient's information to third parties without their consent, the patient also requires consent while conducting critical medical interventions. More importantly, nurses should integrate the principles of social justice such as advocacy, diversity, non-discriminative measures, and gender quality while providing care services.

Conclusion

Theoretical and ethical issues play a vital role in advanced nursing practice. Precisely, it is evident that depression is becoming a primary concern among adults in the United States. While this condition creates a significant impact on the health wellbeing of the patients, few patients diagnosed with the condition receive patients from psychiatrists. Therefore, understanding the complexities and the most effective evidence-based practices is vital in helping nurses in performing the pharmacologic vs. non-pharmacologic treatment of adults with major depressive disorder (MDD).

References

American Sociological Association. (2019). Code of Ethics. Retrieved from http://www.asanet.org/code-ethics

Hegge, M. (2013). Nightingale's environmental theory. Nursing Science Quarterly, 26(3), 211-219. doi: 10.1177/0894318413489255

Holvast, F., Massoudi, B., Oude Voshaar, R. C., & Verhaak, P. F. M. (2017). Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis. PLOS ONE, 12(9), e0184666. doi: 10.1371/journal.pone.0184666

Sher, A. N. A., & Akhtar, A. (2018). Clinical application of Nightingale's theory. Journal of Clinical Research & Bioethics, 9(4), 1-3. doi: 10.4172/2155-9627.1000329

Zborowsky, T. (2014). The legacy of Florence Nightingale's environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34. doi: 10.1177/193758671400700404