Ethical Issues in Community Health Nursing in Botswana

Purpose:

The purpose of this study was to explore ethical issues that Community Health Nurses are faced with in clinics in primary health care settings and home based care settings.  

Methods: An exploratory descriptive qualitative design was used to interview 12 Home Based Care Nurses in five urban and rural districts in Botswana. Content analysis was used to analyze the data. 

Results:

Registered Nurses employed as Community Home Based Care nurses were interviewed and their ages ranged from 23 to 56 years.  The themes that emerged included: Respecting client’s wishes (autonomy and confidentiality), Negotiating political interference in care (changing operational rules for patients’ care and non-procedural conflict resolution for community members for political gain), Caring in the context of risk, and System issues. The findings indicate that the nurses’ goal was to optimize good. However, there was evidence that there was tension regarding whose good should be upheld. The HIV and AIDS scenario created many ethical problems that require health promotion strategies. They expressed concern over shortage of staff and scope of practice issues. 

Conclusion:

There is need for support and continuing education in ethics for community based nurses in practice. Ethics committees should also be established in PHC settings. Health promotion on HIV and AIDS must be continued.