ETHICAL ISSUES IN COMMUNITY HEALTH

 
 
 
 
AND HOME CARE NURSING

The restructuring of the health care delivery environment adds new dimensions to the ethical issues involved in the practice of nursing. This paper examines some of the more significant of these issues. For purposes of discussion, these issues grouped into concerns related to access to health care services, abuse of patients, client rights, and professional responsibility.

As a result of a combination of factors (increasing costs of health care, changing societal values, advances in treatment therapies, changing demographics, and many others), the delivery of health care services in the United States is undergoing rapid and important change (Mentkowski, & Doherty, 1984). Changes in the locus of delivery of health care serviceshome health care, community health services, ambulatory care, and so forth, as opposed to hospital delivered servicescreate new opportunities for, and new demands on the professional nurse (Weiss, 1983). Economic factors in the new health care delivery environment propel administrators into roles, wherein they attempt to impinge on the autonomy of all health care professionals (Particelli, 1984; Drake, 1982). Public health concerns threaten the traditional patientcentered orientation of the professional nurse (Fry, 1983).

The restructuring of the health care delivery environment adds new dimensions to the ethical issues involved in the practice


     
 
 
 
    

 

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in the state. The funding of health care costs would also become more equitable, as all employers began funding a fair share of the burden. Mushrooming medical technology also threatens access for many individuals (Pera, & Gould, 1989). The high costs associated with this technology places it outside the reach of millions of individuals, particularly those individuals who depend upon home health care, or upon community health services (StuartSiddall, 1986). The access dilemma is, in the late1980s, developing into a major health issue in the United States. Problems associated with access to health care services will likely worsen significantly, before beginning to improve. Abuse of Patients Abuse of patients has become a significant issue for health care professionals in the decade of the 1980s. Problems of abuse are most critical with respect to wives, children, and the elderly (Thobaben, 1985). For the professional nurse, patient abuse is not a situation which simply demands the extension of care to the victims. On one hand, health care professionals have a moral obligation to these victims to insure that the victims are removed, to the extent possible, from abusive situations (Sallad

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