Ethical considerations in rural health nursing

Nurses are the health workers most frequently found providing primary health care services in rural communities throughout the world. In these settings, often with limited resources and far from professional support systems, nurses may encounter ethical dilemmas quite different from those experienced by their colleagues in urban hospital settings. Consider the following example from a remote island community. A young nurse with two years experience in an urban hospital is posted to a remote village. In this country there are very few doctors, so nurses diagnose and treat common health problems. On this day a traditional political leader, a middle-age man, is brought to the small clinic by his adult son to be treated for his cough. Other patients are waiting to be seen, but the son makes it clear that he expects his father to be cared for immediately. The nurse doesn't think it is right to give preferential treatment, but the other patients back away and she defers to the son's demands. The nurse examines the man and concludes that he has a common viral infection requiring only symptomatic treatment. When she tries explaining this to the patient, he becomes annoyed and insists that what he needs is a penicillin injection. That's how the last nurse working in this clinic had treated him when he was sick and he had recovered within days. Finally, the young nurse overwhelmed by his age and status and under pressure from his family gives the injection. Shortly afterwards the patient collapses in shock and very nearly dies. The family blamed the nurse, and the community council demanded that she be removed. The case was eventually investigated by the authorities, and the nurse was formally reprimanded for giving the patient an unnecessary injection which caused him harm. Rural nurses-indeed all rural health workers-need support in order to maintain ethical standards in practice. The purpose of this paper is to examine four potential sources of such support: nursing education programs; the Ministries of Health; the law; and the professional nursing organization.