Posted at 10.07.2018
Introduction: This task illuminates the use of ethical decision making model in taking decisions while taking care of patients in their finest interest. Moral decision making is very challenging for the health care specialists while working for the huge benefits and the pursuits of the patients.
While caring for the dying or the terminally ill patients, healthcare providers address various issues of pain and hurting with regards to the psychological, religious, mental and physical complexities of the individual getting the terminal condition.
The moral decision making models become guide to make decisions in various complex situations addressing various issues which include ethical concepts, person's own worth and values, institutional procedures, legal factors and cultural values
Nurses can improve results of honest decisions by:
preferring customer wishes.
encouraging the value of ethical issues in health care of patient.
obtaining necessary assessment on moral concerns
becoming involved in the development of plan on ethical issues
advocating for safe and experienced nursing good care within Alberta communities
encouraging and facilitating co-operation and cooperation between pros and
between companies to effect advancements within health care
taking part in the development of practice expectations, issues claims and position
papers on professional issues
dealing with colleagues to recognize crucial honest issues for the career,
the execution of evidence-based practice
shaping the path of health-care reform
linking of source allocation decisions to client outcomes
In this task i am going to use STORCH Model for moral decision making.
This model originated by Jan Storch for use in health policy decision making, but later it was modified for use in ethical decision making.
Dr. Storch advised the use of this circular model as a way of reminding us that it is important to return to each account even as we move towards decision making. This model will involve three major steps:
Information and identification
Clarification and analysis.
Ethical concepts--- Autonomy
Social objectives and Legal requirements
Range of actions/ anticipated consequences
Professional code of ethics
One's principles' beliefs, ideals of others and value conflict
3. Actions and Review.
Case review: Eighty four yrs. old Mr. Adam, was admitted to the ICU. He has been experiencing neck malignancy for 1. 5 years. Now his disease condition is becoming worsen. His life expectancy is about three months. He has difficulty in deep breathing, difficulty in swallowing and cries with pain. He's on mechanised support and has nasogastric tube set up. He lives with his 82 years old wife.
He was a productive social employee. His wife explains to that he is convinced in living life in a productive way. He used to operate a vehicle cancers patients to the treatment centre voluntarily. He has two daughters who reside in Ontario, however now they are simply here to visit their father. He requested the nurse to eliminate the nasogastric pipe and mechanical air flow as he does not want to exist in this manner. His wife decided to his decision as she will not want to see him enduring any longer. She want him to pass away peacefully and painlessly.
According to Storch Style of moral decision making, in this case scenario,
Information and recognition: Nurse Have to gather everything regarding Mr. Adam.
Nurse can organize a family meeting including his partner and the daughters also the family medical doctor can be engaged. She should listen to the views and concerns of all the family related to the submission of the individual.
Nurse should think about the condition of the individual, Mr. Adam is terminally ill and now as his condition is becoming worsen he is becoming totally dependent on life support system. He has severe pain which he cannot tolerate.
His life span is very short and the prognosis is absolutely poor.
Mr. Adam is experiencing throat cancer which is on the previous level but his decision making capacity can be intact, so nurse should assess the reason behind his decision. Nurse should assess if there is depression, as it might effect the decision of the individual.
Mr. Adam is staying alone along with his wife, so the money may be limited by bear his stay in hospital.
He was a dynamic social worker. Mr. Adam used to drive cancers patients to the treatment centre. He may have strong interpersonal connections and an optimistic quality of life.
Mr. Adam feels in dynamic living of life not in this dependent manner and he spends his life living for others and assisting others in their time of need. He previously very positive attitude towards life. He feels in life well worth living rather living.
Nurse should evaluate the goals of his family regarding the condition of the patient. Mr. Adam's wife and little girl should be asked about their anticipations for Mr. Adam's health status and prognosis. His daughters live far away from him so they may well not have just as much acquainted with his condition as Mrs. Adam do.
Nurse can seek advice from the doctor about the condition of the patient and also about the results of the decision.
Identify the surrogate decision manufacturers for Mr. Adam.
According to the next step:
Clarification and evaluation: nurse should assess the different worth associated with Mr. Adam.
Mr. Adam's personal beliefs regarding life are worth living life. He thinks in living life in a effective and positive way.
Nurse should assess the cultural values of the patient, what role ethnic worth play in his life. What his culture says about life and fatality.
Nurse should also retain in view the religious values of the patient. What role does his religion play in his life? If the religion allows for hastening the fatality process.
Professional values play an important role in ethical decision making. Nurse should think about the professional beliefs from the removal of life support system.
Nurse should evaluate the prices of the members of the family regarding the decision of hastening fatality of their family member.
Mr. Adam's partner is in favor of his decision to remove life support as she does not want to see him suffering. She desires him to die peacefully and painlessly.
Consider the moral principles.
Principle of Autonomy: Corresponding to this basic principle patient has the right to choose for himself, within this circumstance Mr. Adam is autonomous and deciding removal of life support system. He instructs the nurse that he will not want to live life like this.
Nurse should respect his autonomy towards the life span and should consider his decision and wish while taking actions.
Principle of non maleficence: Relating to this principle nurse should do no injury to the patient. In the above case situation,
patient want to avoid the life support and continuing the treatment may not in favor of the basic principle as it is against his wish.
Principle of beneficence: Regarding to this basic principle, nurse should do good for the individual. Here patient is asking for stopping life support system but it does not provide any advantage towards his condition at exactly the same time it works in favor of his desire to die.
Principle of justice: According to this principle, all persons should be evenly provided with health care services. In this case patient will get required healthcare needs.
Consider the interpersonal objectives and legal requirements:
Nurse should look for just about any similar record in a healthcare facility. Identify any earlier similar circumstance in the establishment, so that she/he can look for the procedures and steps that may be taken.
Nurse should check a healthcare facility policies about the hastening of fatality of the patient. She should evaluate that what steps can be studied in line with the policies.
Nurse should require any legal records of client's decision making government bodies. She can ask for any legal will or progress directives.
While considering the various areas of model nurse should assess that what possible selection of activities can de done.
Considering the info provided, Mr. Adam is a solid social individual, he put in life doing beneficial, now as he's chronically suffering and centered which for him is not worthy of living. He's old and the life expectancy is poor and yes it offers him severe pain. His partner want him perish peacefully. As well as the financial sources may be limited by continue life support.
The ethical concepts offers him the right to choose for himself.
According to Canadian Nurses connection code of ethics for authorized nurses, there are seven main nursing prices:
1. Providing safe, compassionate, experienced and honest care
2. Promoting health and well-being
3. Promoting and respecting enlightened decision-making
4. Preserving dignity
5. Maintaining personal privacy and confidentiality
6. Promoting justice
7. Being accountable
( CNA code of ethics for rn)
Nurse should consider the professional code of ethics while making decision for the patient that whether she is going corresponding to provided professional suggestions.
In this case nurse should follow the professional code of ethics while caring
And deciding for Mr. Adam.
Nurse can consider her own worth and values regarding life and fatality in empathizing and understanding the needs of the patient and family.
Nurse should comprehend the prices and values of the persons involved in the decision making for the individual. The way the stopping of life support system impact the family members? What they imagine about loss of life process?
Mr, Adam's better half believes in his peaceful death.
Nurse should evaluate when there is any conflict between the worth of patient, members of the family, profession, culture, religion.
Action and review: in this case scenario action must be decided according to the various perspectives proposed by the model.
Nurse can check what she can provide to the patient, whether the request to hasten dying is made under melancholy or really in relevant methods to patient.
If it is because of unhappiness, what nurse can do to promote and facilitate quiet and peace in your thoughts of patient.
How she can offer compassionate care and peaceful fatality to the individual.
If patient would like to perish, nurse should t check what she can do while regulating a healthcare facility policies.
All the perspectives distributed by the model should be reviewed before taking any actions.
Conclusion: Within the nutshell, I can say that Storch Model is the best suited model to the aforementioned case scenario as it covers all the issues and perspectives related to your choice. The honest decision making skill can attained by reading literature and with the practice experience. These decisions play important role in the lives of patients and nurses as well. There is need of honest romance between patient and nurse. There should be better knowledge of nurses own beliefs, beliefs, patient and his prices and beliefs, professional values, institutional guidelines.