Ethical Issues in Advanced Nursing Practice

Book Reviews Ethical Issues in Advanced Nursing Practice Editor: Karen Bartter Publisher: Butterworth-Heinemann Year: 2001 Advanced practice nurses face new and exciting challenges as they push forward the traditional boundaries of nursing. Ethical Issues in Advanced Nursing Practice, through a collection of essays, aims to offer ‘insight and guidance on a variety of issues that are likely to be encountered by the advanced nurse practitioner in everyday practice’. The essays are authored by nurses currently practising as advanced practice nurses in the UK and who have studied ethics during their Master’s in ANP or by academics involved in some aspect of advanced nurse education and curriculum development in the UK. The contributors share their reflections on ethical implications in a variety of clinical settings. This book offers a detailed background of information on ethical issues in a range of practice-focused areas. The concept of advanced nursing practice does not enjoy consensus in definitions, roles and responsibilities, educational preparation and training, scope of practice or areas of practice. Although, Karen Bartter (editor) presents a text that offers a thoroughly described theoretical background for ethical issues, her implication that the issues and dilemmas presented are limited to nurses in advanced practice can only be accepted within the UK perspective of advanced nursing

Number of pages: 141 Cover: Paperback ISBN: 0-7506-4955-0 practice. The UK perspective of advanced nursing practice in this book is supported by a significant number of references to the United Kingdom Central Council. For all others, this book presents a myriad of information relating to ethical situations in a variety of clinical contexts that will be of benefit to any practicing nurse, from new graduate to advanced practitioner. Ethical Issues in Advanced Nursing Practice is organised into eight chapters. The first chapter explores broad expectations of advanced nursing practice in the United Kingdom as well as ethics and the advanced practice. The next seven chapters each explore ethical and legal implications in different situations from a variety of perspectives. Practice-areas of focus include contraception and the under-16s (Chapter 2), abortion for unwanted pregnancy (Chapter 3), termination of pregnancy for foetal abnormalities (Chapter 4), childhood immunisations (Chapter 5), informed consent (Chapter 6), witnessed resuscitation (Chapter 7) and advanced directives (Chapter 8). The user-friendly format is easy to navigate. Each chapter is unique in its description of ethical issues in particular clinical contexts from the individual advanced nurse author’s perspective. Nurses encountering any of the specific issues can easily go directly to the relevant chapter without having to

read the previous chapters for context. For example, an emergency room nurse battling the dilemma of whether to allow family members to be with their loved ones during a resuscitation event would find the chapter ‘The advanced nurse practitioner: empowerment in witnessed resuscitation’ insightful. A nurse working in a sexual health clinic may appreciate the perspective offered in the chapter ‘Contraception and the under 16slegal and ethical implications for the advanced nurse practitioner’. The community health clinic nurse may be enlightened by the information in the chapter ‘Ethical considerations in childhood immunizations for the advanced nurse practitioner’. Nurses working in theatres would benefit from the information presented in the chapters ‘Informed consent and the advanced nurse practitioner’ and ‘Advanced directives - considerations for advanced nurse practitioners’. Overall, the book does have something to offer any nurse with an interest or concern relating to ethics and ethical decisionmaking, especially in the specific clinical situations presented. One limiting feature of the book is the repetition of information found throughout the book. Although each chapter discusses ethical and legal issues relating to a specific main theme, they all present very similar background information. For example, each chapter gives detailed information on the paternalistic nature of medicine, the differences between utilitarian and deontological

philosophies and their influence on the decision making processes of health professionals, and the concepts of beneficence vs non-maleficence. The repetition of information only serves to flag the ‘written for assessment’ quality of the individual chapters. Another drawback is that Ethical Issues in Advanced Nursing Practice presents a very simple, black and white view of ethics and ethical decision making and leads the reader to develop either a utilitarian or deontological view of the world to guide them in making the right decision. What is lacking in the background information is reference to the grey areas and the myriad of other philosophies that can influence our ethical decision making processes, such as hermeneutics, phenomenology, relativism, etc. Ethical Issues in Advanced Nursing Practice is an easy first reference in any collection on ethics because of the thorough explanations of the historical theoretical background on ethical issues. It serves as a starting point for those exploring the concepts of ethics, but is limited in describing alternative theories or philosophies that may have an effect on ethical decision-making in today’s healthcare environment. Reviewer: Sonya Osborne RN BSN GradCertPerioperativeNursing MNurs(Research) Project Director, The Canberra Hospital & University of Canberra Research Centre for Nursing Practice