Explain in what ways this issue evidences the characteristics of an ethical problem.
The way how this issue evidences the characteristics of an ethical problem is that it is the opposite of what the patient demands. It is a situation in which an individual feels compelled to choose between two or more actions that he or she can reasonably and morally justify, or when evidences or arguments are inconclusive (Ryan, 1998, p. 341). She specifically finds the IV line to be agitating and is keen to remove it herself. The nurses decided to tie the patient’s arms to the bed to provide safety for the patient and to keep her from pulling out the IV line. This measure, in effect, made the patient more agitated serving as the main ethical problem.
Identify the ethical principles implicated by the issue and explain the relationship of these to each other.
Professional nurses are faced with issues on nursing ethics. Nurses are called upon to be
involved in decision making that requires tremendous responsibility and wisdom in the care
of patients as well as with the other health care professionals. The four principles involved in nursing ethics are autonomy, beneficence, non-maleficence, and justice (Zimmermann, 2002, 301). The three theories of deontological, consequentialist, and virtue theory affect how the four principles of nursing ethics would triumph on the nursing decisions when it comes to patient care. Deontological theory holds that any act is either right or wrong regardless if it was done for the greater good. Consequentialist theory gives importance to the greater good hence does not perceive short term violations as wrong but a justified wrong act. Virtue theory is particularly relevant to nursing since virtuous conduct is linked to therapeutic healing behavior and promotion of human health and wellbeing (Gastemanset et al, 1998).Thus virtue theory permits unethical action as good depending if your motivation is
Patient autonomy and Beneficence
There is a potential dilemma in autonomy versus beneficence in this case of the patient. When a confused elderly patient desires to remove the IV line and is kept under restraints on her bed, it poses many issues on whether the four principles of nursing ethics are inherent. The concept of autonomy involves the concepts of advance directives and informed consent. The ethic of beneficence is to promote the welfare of other people through actions motivated by mercy, kindness, and charity. Beneficence in nursing has examples such as practicing sterile techniques when changing an infiltrated IV set. To put it more simply, the conflict of autonomy versus beneficence on nursing is when nurses are confronted with having to choose between respecting the patient’s right to self determination or autonomy and the principle of beneficence.
The patient’s autonomy is compromised at this given health condition thus necessitates the nurse for drastic measures to maintain the IV line patent. In a consequentialist theory, it is acceptable to strip off the autonomy of the patient because the act of restricting the patient’ arms is done for her recovery. Elderly patients who are confused require immediate attention to restore or maintain effective functioning of the brain through nutrition and hydration. It is done to give priority for an effective nursing management of the confused patient. In a deontological view, the act of tying the patient’s arm to keep the IV line intact is wrong as it denies the patient of her right to refuse and autonomy. In this theory, it neglects the purpose of such act but focuses if the act is right or wrong.
Nonmaleficence and Justice
Nonmaleficence means to do no further harm and is considered to be an overriding principle for everyone who undertakes the care of the patient (Munson, 2004, p. 772). When health care professionals ever violate the principle of nonmaleficence, it is usually in terms of a short term violation to provide a long term greater good. The plan to achieve the greater good after resorting to the short term violation can be viewed as a consequentialist theory.
Justice is the final principle in health care ethics as well as the basis of a duty-based or deontological or ethical theory. To make it simple, the concept of justice is all encompassing in the field of ethics (Beauchamp & Childress, 2001). Justice means to do whatever is right and the demand to be treated justly, fairly, and equally.
When health care workers decide to act on consequentialist theory and virtue theory rather on deontological theory, it is essential to maintain the respect of the patient with informed consent from kin or family members of the patient. The principles of autonomy and beneficence can be in conflict especially when the patient is in a depressed level of consciousness and mentally challenged. The ethics of nonmaleficence and justice are not absolute hence is compromised when the perspective of consequentialist theory rules over the deontological theory.
Discuss a possible resolution to this problem with reference to an ethical decision making model.
A majority of problems concerning ethics encountered by nurses are important. These situations involve conflicts of values in fairly routine patient care situations. Therefore, a values-centered model of ethical decision making can help nurses for a possible resolution. The ethical decision making model consists of four questions as discussed as follows:
What is the story behind the values conflicts?
In the scenario given, the nurse begins to discover how the problem is defined by the parties experiencing the problem or dilemma whether continue IV therapy or discontinue IV therapy. The said dilemma needs to be told by respective parties in terms of factual information. The parties who are involved are family members, then nurse, the attending medical practitioner, other allied healthcare workers, etc. In this way, the full story of the dilemma is determined, the scope of the problem is made explicit and the various interpretations of the said problem and values of the parties involved will be clarified. The family members of the patient may view the IV therapy as an agitating factor for the patient while the medical health team considers it essential to achieve nursing outcomes.
What is the significance of the values involved?
The significance of the values involved offers an insight into the moral and nonmoral nature of the values held by both party and their potential cultural, religious, personal, professional and even political origins. When the values of the patient and family members are known, it helps parties to respect each other’s values in the process of decision making.
What is the significance of this conflict to the parties involved?
The conflict in the value system of an individual will lead to a decision that affects the healthcare of the patient. The patient finds the IV therapy to be uncomfortable given her state of confusion. The family members can be concerned as this conflict is perceived to be unpleasant to the patient. Thus, it is a meaningful decision for them as it is for the health care team who finds it important to hydrate and provide nutrition to the patient.
What should be done?
The course of action in this case is based on the best judgments from a careful consideration of the value conflicts and moral meaning of the situation to the individuals involved. Given the patient is admitted under the care of the health care team then it is most likely that the said team and patient’s family members should prioritize the recovery and wellness of the patient.
The nursing management of acute confusion in geriatric nursing starts with an understanding that it is not a normal outcome of aging. Nutrition and hydration programs are important to the effective functioning of the brain. Dehydration is common among older adults
because of age-related changes in thirst sensation and frequent use of diuretics (Stanley et al, 2005, 349).
The family members of the patient can be especially helpful if they remain at bedside of the patient during hospitalization. The patient is agitated but can not be removed from intravenous therapy as part of the medical management. Hence, there other options to lessen her agitation state with a familiar voice, face, and approach (Rowe, 2007, p 65).
Discuss the significance of this issue for your professional practice as a nurse or paramedic
The ethical issue of how nurses cajole patients into accepting treatments or in this case nursing management is essential but unpleasant. In most instances, however, the nurse has no reason to question the ethics of the treatment because it is in keeping with what the nurse believes is in the patient’s best interest.
In a vast majority of cases, the health care team usually honors the patient’s decision after careful consideration with the principle of respect for autonomy. Though there is also a choice to override those wishes and compel unwanted treatment or nursing management. Two justifications are commonly offered: patient lacks competency or the patient’s decision presents a danger to her or others (Olsen, 2007, p. 51). While autonomy is deemed necessary as part of the nursing ethics, it is not absolute and “automatically” granted when the patient simply decides not to undergo the treatment advised to her. The rights of the patient and inherent limitations of any situation make it necessary to balance individual autonomy against other’s right and duties (Hankins et al, 2001, p. 643). Therefore, it is the nurse’s decision to advance directives, documentation of patient wishes before mental impairments such as the lack of decision-making capabilities (changes of level of consciousness, emotional distress, effects of age, inability to understand and judge alternatives) which make it easier for the system to differentiate autonomy of patients versus nurse’s initiative for the patient’s well-being. Health care workers including nurses and paramedics need to recognize that patients do not lose their rights to autonomy simply because their capacity to make decisions is impaired. Every effort must be directed to discover the preferences of the patient. On the contrary, if the case is similar to the situation mentioned where the elderly patient is confused and seeks to remove the IV therapy then health care workers must rely on other ethical principles of guide care.
The pivotal position of nurse who focuses on intravenous therapy provides them an opportunity to determine ethical problems in care that may not be obvious to others in the health care team. IV nurses should assess possible ethical problems, behave as a role model for ethical care, integrates a problem solving approach in scenarios that poses ethical concerns.
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Nurses face more and more ethical dilemmas during their practice nowadays, especially when they are taking care of the patient at end of life stage. The case study demonstrates an ethical dilemma when nursing staff are taking care of an end stage aggressive prostate cancer patient Mr Green who expressed the suicide thoughts to one of the nurses and ask that nurse keep secret for him in Brisbane, QLD, Australia.
Ethical dilemma identification
The ethical dilemma is identified as “if the nursing staff should tell other health care team members about patient's suicide attempt without patient's consent”.
To better solving this case and making the best moral decision, the ethical theory, the ethical principles and the Australian nurses' code of ethics values statement, the associated literature relative with this case are analyzed before the decision making.
Ethical decision making
After consider all of the above factors, in this case, the best ethical decision for the patient is that the nurse share the information of Mr Green's suicide attempt with other health care professionals.
In Mr Green's case, the nurse chose to share the information of Mr Green's suicide attempt with other health care professionals. The nursing team followed the self-harm and suicide protocol of the hospital strictly, they maintained the effective communication with Mr Green, identified the factors which cause patient's suicide attempt, provided the appropriate nursing intervention to deal will these risk factors and collaborated with other health care professionals to prefect the further care. The patient transferred to a palliative care service with no sign of suicide attempt and other self-harm behaviors and passed away peacefully 76 days after discharged with his relatives and pastors accompany.