Posted at 10.03.2018
Mr. White is a 70 season old male patient who has been rather healthy throughout his very existence besides some issues with pneumonia before couple of years. He was driving along the road last Monday where he strike a patch of black glaciers, swerved off the street, and crashed into a tree. He lost consciousness and suffered small abrasions to his biceps and triceps, thighs, and face. When he regained consciousness, he explained he felt cold, numb, and fatigued as several paramedics hovered over him inserting a collar around his neck and a vertebral board underneath him. He was very confused and was advised never to move as they oriented him to person, place, and time. He was taken to the emergency room where he was put him on air via nose and mouth mask and D5 Ѕ normal saline 100ml/hr. He was used in the ICU after lung problems and a tracheotomy was put to open his airway and invite for oxygen exchange. Each day his family has been at the hospital assisting him and praying he'll recover from this severe crash.
The nurse looking after him was reviewing his medical files and noticed that he's a do not resuscitate patient and that he will not want to get any life sustaining treatments that will extend his life. The patient has been awake, alert, and oriented and confirmed skilled two days before, which allows him to make decisions for himself. His little girl, Mrs. Black, advised the nurse that she doesn't know very well what she would do without her father because he is the rock and roll that keeps their family jointly. The rest of the family replied that these are his hopes and we will have to simply accept what he has requested, though it saddens us to believe we may lose him soon.
During a routine test a few days ago the medical doctor noticed that his labs were not within normal limit and bought stat tests to determine the problem. The torso x-ray ordered validated he had pneumonia, but also revealed he was suffering from metastatic lung malignancy. The physician informed the nurse of the malignancy and mentioned that Mr. White is still very vulnerable and preventing for his life. We will notify him and his family when he is more steady and in a position to be strong enough to consider the news headlines.
Identify the Problem
The nurse is prepared of the confirmation that the patient indeed is experiencing cancer supplementary to his car accident and pneumonia. Does indeed she advocate for the patient's right to autonomy in delivering the news headlines to him and his family or will she follow the doctor's orders and withhold the news since the physician believes that revealing to him will only get worse his condition and lead to a loss of expect all engaged? The nurse thinks that withholding information is certainly going contrary to the patient's protection under the law to make his own decisions. The nurse needs to do what is best for the individual and thinks that keeping these details from the individual is being dishonest and is not what any functional nurse would do in this situation. However, she actually is unsure of the best approach in responding to the issue.
Gather Relevant Facts
A sound doctor-patient relationship can be an essential element when carrying out decisions based on a patient's look after treatment. Studies show a correlation between your quality (communication) of physician-patient romance and better (professional medical) final results (Stewart, 1995). The physician and the patient have to have a strong marriage with the patient that includes sensible communication, fidelity, knowledge founded learning, beneficence, and Nonmaleficence.
There are four different styles to a doctor-patient relationship such as consumeristic, default, paternalistic, and mutuality human relationships. The mutualistic way is considered the optimal relationship to own when both the patient and the doctor bring both of their ideas and resources to the table and make a commitment to utilize one another to resolve disagreements in a respectful way. Paternalism consists of physician focused attention because the decision is dependant on what the medical doctor believes is best for the patient and not necessarily what the individual wants. Within the scenario, the medical doctor believed that it would be in Mr. White's best interest to hold off revealing him the news headlines of his tumors until he was better and stronger, but this may not have been what Mr. White could have made the decision (Roter and Hall, 2006).
At the beginning of the 1960's, medical procedures were starting to address the moral problems with paternalism by a patient's to autonomy and prepared consent. Problems with paternalism commenced to arise anticipated to a rise in consumerism, the women's motion, and laws handed that allowed for the protection under the law of patients in their health care. The patients wished to be more involved in their treatment in knowing about their health, standard of living, survival, and mortality rates of their condition. As a result, a physician's violation in work to the individual caused an increase in lawsuits. Medical workers commenced to be confronted with a hard decision in deciding what important information the patient needed to find out about their condition (Wear, 1993; Charles, Whelan, Gafni, 1999).
Legal and even more paternalism were in conflict from the example used with Mr. White. Legal paternalism foundation decisions around pursuing regulations created by federal government, state, or local level while moral paternalism foundation decisions using ethical principles. The medical doctor was going against legal paternalism because truth-telling is now considered a legal subject and the experienced patient is usually to be informed of all matters related with their health, unless of course the patient is deemed incompetent. The doctor was trying to apply moral paternalism because he believed that withholding the information from the Mr. White was beneficial in a way that he'd not be strong enough to take care of the news headlines of his cancer and cause his condition to aggravate or not improve (McCarthy and Schafermeyer, 2004).
The debate today about paternalism is whether it is appropriate for doctors to make alternatives about patient's treatments in their health care when they could believe that the individual may possibly refuse the decision if they were correctly enlightened. Is it justifiable for doctors to start the treatment given that they feel the long-term benefits to the individual would be provided and at some point the patient would agree that the activities of the physician were appropriate? Certain situations helps it be challenging to learn exactly what is best for the patient, which is hard to know when a physician is carrying out an intervention that is in the patient's best interest or their own interest. Mills is a solid believer of autonomy and battles for patient's protection under the law. He believes that each individual has the ability to identify why is them happy and that indie exercise of aspirations is a large part of their joy. Kant also helps patient's protection under the law and believes that every individuals has a responsibility to talk their autonomy. (McKinstry, 1992).
The Patient Bills of Privileges of 1973 included the physician's responsibility to see the individual on all things related with their condition enabling the patient to make decisions based on this knowledge. The Invoice was carried out to diminish the incident of malpractice by lowering the dissatisfaction of patients that meet the criteria for much more liability using their providers (Faden and Beauchamp, 1986). Regulations requires that medical information shown to the individual be in plain language that can be voluntarily comprehended and adequate in quantity. A health care provider who is unsuccessful in attaining enlightened consent may undergo offense charges.
In 1998, the buyer Bill of Privileges and Responsibility Action was completed by President Clinton to help consumers try their own health care by increasing consumer self confidence in medical care system, to provide support in figuring out the reasoning for a audio doctor and a sound provider-patient relationship, and also to help the consumer realize the top role they carry related to their rights and obligations of these heath good care and recovery. The rules included several privileges of the patient to create the best quality health final result. (Shalala, 1999).
Patients are qualified to give up to date consent unless reviewed and evaluated to have mental deficits and incapacity. Knowledgeable consent must follow several steps in order to be valid which include informing the individual on the diagnosis, the suggested involvement, major benefits, risks, the results or prognosis if an involvement is not carried out, and any significant options with their dangers and benefits. Informed consent should hold true and become carried out in all cases except when the individual is vunerable to serious harm or fatality if the intervention is not completed immediately, the patient voluntarily gives up their right, in case disclosure would cause serious physical or mental health harm to the patient or another person (Wear, 1993). At UPMC clinics such as Magee and Presbyterian private hospitals patients have certain protection under the law and responsibilities they are given such as the right to well known and quality attention from personnel, the right for information in medical data to be stored confidential, the to pain control and management, the right to know diagnosis, reduction, and treatment plans and alternatives given in simple terminology, the right to informed consent before any procedures, the right to refuse any medications, treatments, steps, and many more. This allows the patient to choose what information they might want to know and to carry out care predicated on their desires (UPMC, 2010).
Identify Ways of Ethical Justification
A one who practices consequentialism is convinced a morally right take action is the one which produces a good end result. The doctor was exercising a consequentialitic approach for the reason that he assumed that not sharing with the patient that he had tumors until he was better would cause an improved outcome for the individual over time. He presumed that Mr. White would quit all wish and stop fighting to make it through if he was educated of the news headlines. In deontological theory, an action is right or incorrect based on rewarding a moral responsibility and can't be justified by their results. Even though the physician was trying to do the right thing by not showing the patient that he had tumors because he presumed that this would help save his life, the act was against the guidelines and duty of the physician to inform the individual on information related to his health (Gert et al. , 1997).
Several principles enter into play in the situation such as beneficence, nonmaleficence, fidelity, and autonomy. The nurse will have to advocate for the patient that keeping these details from him and it is family is not doing good. It could in reality cause more injury to the patient since he's unaware of his cancer. The individual might be able to determine treatments that could delay the get spread around of cancer, which could allow him more time to spend along with his family. The experienced patient gets the right to autonomy in deciding what information he'd want to know about his health insurance and the doctor should not be the one to get this to decision. The medical doctor is keeping essential information from Mr. White that may result in an escape in their dedication and ruin the patient's rely upon his healthcare provider (Cassells and Gaul, 1998).
Clarify Relevant Values, Rights, Obligations, of Patient, Self applied, and Significant Persons
The patient has the right to knowledgeable consent if he is seen as capable to make decisions based on his healthcare. It is the physician's responsibility as well as the nurse to respect the individual and inform him of most matters pertaining to his professional medical and making certain the patient demonstrates understanding. If Mr. White was deemed incompetent he might have appointed a family member as a substituted surrogate decision machine to make decisions in his health care based on the patient's beliefs, beliefs, and hopes. If Mr. White did not appoint someone to be a surrogate then the best interest principle would come that can be played and decisions on the patient's professional medical would be dependant on what is the best interest for just about any fair patient in this example. The family will need explanations on the patient's position and what the near future can look like for him. The family would be the ones taking care of him and they'll need acoustics education on how to care for the patient.
Identify If There Is an Ethical Dilemma
The nurse encounters an ethical problem because the alternatives are between two evenly insufficient solutions which display incompatible testimonies. Does the nurse get rid of the patient's right to autonomy in keeping Mr. White's new diagnoses of lung cancers from the him because the physician believed it was in the his best interest or should the nurse take the issue to higher expert to advocate and remember to protect the health, safety, and protection under the law of the patient (Cassells and Gaul, 1998).
Identify Recommendations from Medical and Professional Rules of Ethics
The North american Nurses Relationship code of ethics for nurses was made to help guide nurses behavior when an honest dilemma would happen. Certain requirements in the code advocate the nurse's commitment to their patient's autonomy, while still keeping in the safe practices of the patient (North american Nurses Association, 2001).
Provision 1 claims that the nurse must practice with compassion and respect each patient no matter their values, ethnicity, class, age group, etc. The patient was a 70 calendar year old African American who was simply a doing Southern Baptist and retired bus drivers. The Caucasian, Catholic nurse had to make sure she didn't treat Mr. White diversely because of his pores and skin, the religious beliefs he practiced, or his time (North american Nurses Association, 2001).
Provision 2 says that the nurse's devotion is to the patient and anyone from the patient such as family and friends. The nurse has the ability to advocate for the individual in communicating their needs to the physician in undertaking treatment regarding his health care. The nurse should communicate with the individual and know what information the patient will want specific friends and family to learn. The nurse with her higher level of skill and knowledge can help instruct his family on his condition and care and attention (North american Nurses Connection, 2001).
Provision 3 says the nurse should do all she can to safeguard the individual from any harm or unsafe situations. The nurse would make sure the patient's demands were used through while keeping his basic safety, health, and reduction from any damage. If she believed that the patient was not up to date of his disease and everything treatment programs possible to help wait the progression of the disease, then she would need to address this matter (American Nurses Association, 2001).
Identify and Use Relevant Interdisciplinary Resources
First, the nurse is going to the physician and see if indeed they can work something out to look for the patient's privileges. If the physician doesn't buy into the nurse then your nurse should then talk to the nurse supervisor and move up the latter before highest person is able to confront the problem. If this can not work, the nurse can also get in touch with the individuals who offer with honest concerns/ dilemmas. The nurse can also speak to legal professionals and get legal things set up for the patient's protection under the law to enlightened consent to be granted. The nurse can also get a psychiatrist included who would speak with respect to the patient to verify that the individual is proficient. The nurse may want to get social workers and advisors to help the individual and family finds ways to handle grief and also determine the best care for the patient's prognosis of his like a skilled center, home health, or hospice care and attention.
Identify and Prioritize Alternative Actions/Options
The nurse can speak directly to the individual and his family about the information that is withheld. This should not be carried out since this is not solving the issue between the nurse and the medical doctor and it is going behind the physician's back again. The nurse can make the decision of not informing the individual or family of the news headlines. She could persuade herself that the physician knows what's best for the individual and bringing up the problem would only cause chaos. This is also going against the code of ethics of an nurse in her lack of being truly a patient advocate (ANA, 2001).
The nurse could talk with the medical doctor about the issue she's with the patient's to autonomy and make an effort to work out their variations. Communication is essential for the nurse and the doctor to truly have a sound relationship and interact to solve issues. If the doctor feels this is something Mr. White does not need to learn right now, then your nurse must take the problem to higher specialist which was dealt with above (nurse supervisor, the ethics committee, communal workers, court docket system and reference point hospital insurance policy, legal, and honest principles on the problem).
The nurse can be there for moral help and support build a trusting relationship with the Mr. White when informed of the new identification of cancers and the betrayal from his doctor. The patient may feel injure, confused, angry, and could have lost trust in the health care and attention providers. The nurse can also speak to the family about the matter as well and provide all the alternative treatments that can be completed to help the individual decide what's best for Mr. White. This is completed but only after the patient's protection under the law are attended to.
Select a Morally Justified Action/Option from Alternatives Identified
The nurse must decide as to what she feels any reasonable nurse would do in this example and perform the patient's desires accordingly. She will need to advocate for his protection under the law in decision making and speak to the medical professional. If this won't get solved then take it to higher power. The nurse must address the patient's desires and needs and then your households. If Mr. White can determine that he does not want to carry out any treatments, then his wants have to be addressed. If he chooses he wants to get started on treatments immediately for his cancer, then these hopes would need to be used through.
The nurse talked with the physician about the issue, but the challenge was never resolved. As a result, nurse took the problem into her own hands and talked with the nurse supervisor who confronted her employer and the situation was then taken to courtroom. The judge along with the aid of the jury established the patient must know all information related to his health care and he was properly up to date of his malignancy. Mr. White understood that his tumors was terminal and that he made a decision that he only sought palliative means of care. He wanted to remain comfortable and spend the others of his time with people he loved dearly. The family decided on his decision because they recognized this is what he needed. He was able to make decisions predicated on his health care and was content at being in charge one thing in his life. He was given quality good care by his nurse and he continued to be comfortable throughout his condition. Mr. White passed on peacefully three months later at home surrounded by his family.