Case Report: Application of Quality and Safety Concepts
Introduction
This report will describe an ethical predicament situation encountered by a nurse in line of duty in an emergency department. The predicament will be analyzed using the algorithm for ethical decision making by Catalano’s (2009). A theoretical perspective is used in analyzing the ethical predicament. Several likely solutions to this predicament are discussed. Research instruments for solution evaluation are also identified.
There are many moral situations faced by people working in the nursing profession especially in relation to a growing technological and scientific environment in relation to the development of advanced treatment methods and diagnostic equipment (Range & Rotherdam, 2010). There are many conflicts emanating from the manner in which professionals handle users in hospital environments or in basic networks. Workers face difficulty while trying to solve conflicts due to being ignored by their leaders or due to lack of sufficient support while executing their duties and in professional autonomy. This is likely to cause the feeling of anger, guilt, outrage, sadness, frustration, hopelessness and impotence towards conflict situations (Corley, 2002).
There are four crucial responsibilities for any nurse and they are promotion of health, prevention of illness, alleviate suffering and restore health. The duties require a nurse to promote health, coordinate the care of patients, administer medication, and carry out medical examination, and other crucial such like duties. The process of nursing entails assessment, planning, diagnosis, evaluation and implementation (Parse, 1999).
A working nurse encounters conflict and moral issues in different situations while working. It is not possible to separate conflict from a nurse’s professional life. Among the many conflicting situations include absence of consent prior to handling a procedure, extension of a patient’s life without attention to the quality of that life, questionable or inhumane professional conduct, resource allocation inequalities, and fragmentation of decisions. Moral distress can become part of a nurse in light of the many conflict situations (Lunardi et al., 2009).
Problem Statement
The ethical dilemma encountered by the nurse working in the emergency wing relates to a patient who is 93 years old. The aged patient is moved from the extended care unit. This patient is suffering from Alzheimer’s disease. Due to her fading health she is unable to drink or eat anything, therefore, threatening her life. The patient is also not able to respond to touch or voice and is also non-verbal. The physician in charge of her has concluded that she is unable thrive. The granddaughter to this patient has been given the attorney powers over her grandmother. There is no advanced directive from the patient. The patient’s family emphasizes that their loved one must be taken to an emergency department in order to have her fed through some feeding tube. The family has been made to know that there is a chance that their loved one could survive with some feeding. The ethical dilemma for the nurse in charge of the patient is to identify the patient’s right to demise while balancing the same with the desires and wishes of her family members (Heiser, 2014).
Literature Review
Nurses have to make critical decisions most of the time throughout their practicing careers. The process of making decisions must be informed by the process of making ethical decisions. Ethical decisions involve education of nurses and the experiences gained through practical lessons. Culture and beliefs also inform decision making for nurses. Moreover, motivations, expectations, and different value systems also impact the decisions made by nurses. The code of ethics for nurses and mission statements’ framework support nurses in decision making. Any nurse will employ the ethical standards during decision making in light of the prevailing circumstances (Silva et al., 2014).
Nurses must have professional capacity to examine various situations and come up with spontaneous decisions having considered all possible alternatives characterizing ethical decision making (Silva et al., 2014). Nurses must be able to support their actions and decisions. For this reason a nurse must be confident in their ability to make good judgment in light of any situation by quickly differencing between right and wrong actions. Nurses must have sound moral perception, courage, sensitivity and imagination (Holt & Convey 2012). According to the suggestion of Grundstein-Amaro (1992) a nurse must place great value on the care perspective during decision making. This essentially means that a nurse has to be responsible and highly sensitive about the wishes of a patient during any decision making process.
References
Blais, K.K., Hayes, J.S., (2011). Professional nursing practice: Concepts and perspectives (6th. ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Corley, M. C., Elswick, R. K., Gorman, M. & Clor, T. (2001). Development and evaluation of a Moral Distress Scale. Journal of Advanced Nursing 33(2), 250–256.
Corley, M. C. (2002). Nurse moral distress: a proposed theory and research agenda. Nurs Ethics, 9(6), 636-50.
Deshpande, S. P. (2009). A study of ethical decision making by physicians and nurses in hospitals. Journal of Business Ethics, 90(3), 387-397.
Dreyer, A., Forde, R., & Nortvedt, P. (2009, November). Autonomy at the end of life: Life prolonging treatment in nursing homes - relatives’ role in the decision-making process. Journal of Medical Ethics, 35(11), 672-677.
Eagly, A., & Chaiken, S. (1993). The psychology of attitudes. Harcourt Brace Jovanovich, New York.
Grundstein-Amado, R. (1992). Differences in ethical decision-making processes among nurses and doctors. Journal of Advanced Nursing 17(2), 129–137
Hamaideh, S. H. (2014). Moral distress and its correlates among mental health nurses in Jordan. International Journal of Mental Health Nursing 23(1), 33–41.
International Council of Nurses. (2006). The ICN code of ethics for nurses. Retrieved from http://www.icn.ch/icncode.pdf
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