ASSESSING THE KNOWLEDGE, AND ATTITUDES OF NURSES TOWARDS THE  PRINCIPLES OF NURSING ETHICS IN CAMEROON

CHAPTER ONE

INTRODUCTION

Background of the Study

Nursing is a compassionate occupation that significantly influences the lives, health, and overall welfare of individuals, families, and communities (Nwona et al., 2018). The nursing profession is governed by ethical and legal principles, which serve as instruments for professional conduct. These principles provide nurses with a comprehensive understanding of their responsibilities as they transition from the sheltered environment of school to the broader society (Adewoyin, 2019). However, ethics and the law share a tight relationship, as they both encompass notions like rights and justice. They hold significance in both ethical and legal contexts, serving as mechanisms for regulating and prescribing how individuals should behave towards each other (Chaloner, 2018). 

Nursing ethics and law are essential in the field of nursing due to its focus on providing services that directly affect human life and health. Nurses often meet challenging situations in their work that can create ethical dilemmas. If these dilemmas are not properly addressed, they can have negative consequences for the client and all parties involved. Standards should be established to provide guidance for nurses in conducting themselves appropriately, making sound decisions, and performing actions that are suitable and safe for the client. This will help shield the nurse from legal action (Nwona et al., 2018). The regulation of nursing practice is implemented to uphold standards and the extent of nursing practice in order to attain safe practices (Nwona et al., 2018; Cherie et al., 2019). This profession entails the utilisation of clinical expertise in delivering treatment to facilitate individuals in enhancing, sustaining, or attaining good health, managing health issues, and attaining the highest attainable standard of living. Chaloner (2018) asserts that practical efficacy and ethics must be equally prioritised in order to adhere to good nursing practice. Furthermore, the practice of nursing is authorised by a contract that clearly defines the professional rights and responsibilities, as well as the mechanisms for ensuring public accountability. Law governs nursing practice in nearly all countries. While each country may have distinct legislation, their primary objective is universally to safeguard the general population (Searle, 2020). The reason for this is that each nursing speciality carries legal considerations or repercussions for the practitioners (Lowrey, 2020; Matzo et al., 2020). 

In addition to the interactive aspect of nursing practice, the documenting of nursing actions is crucial as it serves as the legal proof for any nursing interaction and care. Nursing documentation is typically regarded as a legal matter that nurses must approach with utmost seriousness. On the other hand, Adekilekun (2020) asserts that inadequate documentation is a frequently encountered cause of legal disputes in Cameroon. It is essential to have a thorough record of the date, time, and a concise summary of the patient's medical history. Additionally, it is important to include any favourable physical findings, details of investigations conducted, the therapy administered, and directions given to both junior staff and the patient.The progress in medicine and the rise of novel infectious diseases like HIV/AIDS have presented significant clinical and public health difficulties and quandaries, particularly with the matter of medical secrecy. These difficulties emphasise the increasing need of moral judgement in decision-making for maintaining professional standards in nursing education and practice. Nurses frequently encounter ethical dilemmas that necessitate them to make judgements that prioritise the client's best interests while upholding the integrity of all parties involved. Nurses engage in ethical decision-making on a daily basis and often face the need to make moral judgements. Although, nurses' opinions frequently stem from a moral assessment of what is morally correct or incorrect, and there are instances when nurses feel unclear about the appropriate course of action (Chaloner, 2018). This is particularly evident in sub-Saharan African countries such as Cameroon, where there is a noticeable combination of a growing population and a persistently weak economic situation. Furthermore, there is a significant disparity between the demand for healthcare services and the available supply, particularly among the socioeconomically disadvantaged individuals in society. Nurses and other healthcare providers have ethical problems in their professional practice and obligations due to these many challenges (Akpabio, 2019). Regrettably, a study conducted by Adeleke et al. (2020) has revealed that healthcare providers lack comprehension of their individual obligation to uphold medical confidentiality. Amsale (2019) argued that a failure to adopt an appropriate approach in handling various contextual issues in nursing can result in nurses facing ethical dilemmas. Studies have indicated that 77.6% of nurses in Cameroon lack sufficient understanding on the legal elements of nursing practice. While it is clear that nursing law and ethics play a crucial role in healthcare practice, there is a lack of scientific evidence to demonstrate the level of knowledge Cameroon nurses possess on this issue. Consequently, there is a current initiative to fully execute the National Health Insurance (NHI), Community-Based Health Insurance (CBHI), and Private Health Insurance (PHI) in Cameroon. These schemes will exacerbate the challenges faced by nurses, since they are likely to incite various legal actions from healthcare consumers who are becoming increasingly conscious of their healthcare requirements and the responsibilities of healthcare providers (Oyetunde, 2020). Therefore, this study seeks to assess the  knowledge, and attitudes of nurses towards the  principles of nursing ethics in Cameroon.

Statement of the Problem

Currently, there is an increasing public apprehension surrounding the ethical behaviour of healthcare practitioners. These concerns are frequently expressed through complaints on unethical behaviour and a growing reliance on legal action against healthcare professionals, especially nurses (Solum et al., 2020). These matters have also encompassed ethical dilemmas encountered by nurses, such as the acquisition of informed permission, preservation of patient confidentiality, respect for patient autonomy, and addressing end-of-life concerns (Kalaitzidis & Schmitz, 2022). Many instances of unethical behaviour or poor ethical conduct happen due to a lack of education on healthcare ethics. Nurses must possess understanding of health care ethics in order to effectively apply their critical thinking abilities when delivering patient care (Sinclair, 2019). However, nursing graduates with limited experience often lack a solid understanding of ethics and critical thinking abilities. The deficiency stems from their nursing curriculum's emphasis on knowledge acquisition rather than the practical application of knowledge in real-world scenarios (Park et al., 2022). According to a thorough examination of existing literature, only a limited number of studies have been carried out to demonstrate the extent of knowledge and adherence to health care ethics among nurses in Cameroon. Hence, it is in the light of these challenges, the study seeks to assess the knowledge, and attitudes of nurses towards the  principles of nursing ethics in Cameroon.

 1.3  Objectives of the Study

The main purpose of this study is to assess the knowledge, and attitudes of nurses towards the  principles of nursing ethics in Cameroon. Specifically, the study will;

Evaluate the level of knowledge among nurses regarding the fundamental principles of nursing ethics in Cameroon.

Assess the attitudes of nurses towards the application of ethical principles in their daily practice.

Identify the factors that influence nurses' knowledge and attitudes towards nursing ethics.

Proffer strategies for enhancing the education and training of nurses on ethical principles in Cameroon.

1.4  Research Questions

The following questions have been prepared for the study:

What is the level of knowledge among nurses regarding the fundamental principles of nursing ethics in Cameroon?

What are the attitudes of nurses towards the application of ethical principles in their daily practice?

What factors influence nurses' knowledge and attitudes towards nursing ethics in Cameroon?

What strategies can be proposed to enhance the education and training of nurses on ethical principles in Cameroon?

1.5 Research Hypotheses

H0: Nurses in Cameroon have no significant knowledge of the principles of nursing ethics.

Ha: Nurses in Cameroon have a significant knowledge of the principles of nursing ethics.

1.6 Significance of the Study

This study will be vital for nursing educators and training institutions, as it will emphasise the necessity for improved ethics education and professional development programs. The study will provide evidence-based suggestions to healthcare managers and politicians on how to enhance ethical standards and ensure that nurses possess the necessary skills to make ethical choices that prioritise patient care and maintain professional integrity.

Furthermore, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to the knowledge, and attitudes of nurses towards the  principles of nursing ethics in Cameroon.

1.7 Scope of the study   

The scope of this study is boarded on the knowledge, and attitudes of nurses towards the  principles of nursing ethics in Cameroon. Empirically, the study will evaluate the level of knowledge among nurses regarding the fundamental principles of nursing ethics, assess the attitudes of nurses towards the application of ethical principles in their daily practice, identify the factors that influence nurses' knowledge and attitudes towards nursing ethics and proffer strategies for enhancing the education and training of nurses on ethical principles.

Geographically, the study will be delimited to nurses in Cameroon.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Nursing: profession and practice of providing care to individuals, families, and communities to maintain or improve their health and quality of life.

Ethics: set of principles and standards that guide moral conduct and decision-making.

Knowledge: Knowledge is the awareness, understanding, and information that a person gains through experience, education, or learning. It involves the comprehension of facts, truths, concepts, and skills that one can use to make decisions or solve problems.

Attitude: Attitude is a person's settled way of thinking or feeling about something, often reflected in their behavior. It encompasses an individual's beliefs, emotions, and tendencies towards a particular object, person, event, or situation.