I was assigned to take care of a patient who had lung cancer and was in a critical condition though he was able to sustain a good communication. The patients family members were concerned that if he knew his situation he may be worried and suffer more before death if the information was disclosed. They were emotionally affected that they would visit the hospital rarely to avoid the patient noticing their worry. To compensate their inability to visit frequently, they requested to receive updates about the patient condition often through mobile short messages. The family members wanted the patient to be informed that he was suffering from another disease that was curable, but required almost the same processes he was undergoing. Moreover, they insisted that they needed their requests and conditions only known to me among the hospital staff to ensure a high level of confidentiality. The patient himself kept on insisting he wanted to know the progress and the diagnosis made on his health. In the light of principles, code of ethics, professionalism, and principles the demands raised in the taking care of the patient lead to an ethical dilemma.
Moral Distress Experienced
As a patient advocate, nurses should offer the best care possible and make a patient have the highest level of satisfaction (Byrd & Winkelstein, 2014, p. 252). Nurses have a duty to ensure that patients expectations are met in the best way possible as well as ensuring they comply with the set regulations to avoid any possible successful litigation against them. Communication between a patient and the nurse is vital in ensuring that their expectations are met, and the satisfaction level is high. Also, the family members of a patient expect the nurse to offer the best care possible as well as meeting their expectations. In the process of ensuring patient and family satisfaction, the practitioner faces the challenges of choosing the best information that needs to be disclosed to the two parties. The patient advocate should disclose adequate information to the patient and other customers so in efforts of maintaining high satisfaction. In the above case, the moral distress arising was how to ensure all the parties involved were satisfied with the care offered. The meeting of the patients requirement resulted to a contradiction of with the family wishes. Also, the family demands were against the patients preference as well as challenges the existing principles and codes of ethics on patient information disclosure. Therefore, leading to moral distress on the best action to take to meet the demands and remain ethical.
Ethical Decision-Making Model
In the case above, the disclosure of the information through the mobile phone messages threatens the privacy of the patients information because the nurse cannot ascertain the receiver of the message at the time it is sent. Also, the demand by the family members to have their requests not know to other practitioners and cheating the patient are undesired situations in the case. The primary goal of solving the challenges is to ensure that the parties involved in the case get the highest satisfaction possible depending on their expectations (Burkhardt & Nathaniel, 2013, p. 165).
First, as per the nursing principles, a health practitioner as they take care of patients, they should ensure that they offer their services with a lot of diligence and humanity. On top, they are expected to make sure that they show sensitivity and compassion to the patients, their family, and any other caretaker accompanying the patient in the hospital (Lachman, Swanson, & Winland-Brown, 2015, p. 364). The application of the principle leads to satisfaction of all the parties involved in the following up of the current patient situation. It also boosts the confidence of the patient and other customers in the health centers medical service offered. Showing compassion includes having sympathy, empathy, and pity on others while sensitivity includes ensuring that the health practitioner is careful with their actions so that they do not hurt anyone in the process of care (Kim, Kang, & Ahn, 2012, p. 475). The demands of the patients family lead to a dilemma in the application of the principle because the expectations of the family were different from those of the patient and all were entitled to excellent service with sensitivity and compassion. As an advocate of the patient, being in their shoes, they expect to know the truth about their heath and progress. Failing to update the patient frequently as per their wish leads to lack of sensitivity and compassion and cheating them may not be fair. Telling them the truth and especially when their condition is poor implies a lack of humanity and diligence since it would multiply the psychological suffering of the patient. In the process of offering nursing care, it is expected that the nurse provides the patient with necessary information and hence there is not a line between sufficient and more than adequate information to the patient.
Patients information is confidential and should not be disclosed to other parties, even family members not unless on unique situations. The strict regulations and law leave nurses in a dilemma on how to deal with family members when they demand information about their patient. Therefore, it becomes a point of conflict when the nurse cannot provide patients information to family members who require it. In the case of the patient under my care, I was to deal with a family demanding patients progress as they believed they had right to all information including the treatment details being offered. To worsen the matter, they required an update of the information send to their mobile phone something that was threatening the confidentiality of the information more because it is hard to determine who has access to the cell phone. In other cases, hackers can also receive the messages if they manage to hack the network. Failing to meet their demands would mean as nurse one does not have empathy and it may bring the quality of care to a question by the family members because they would be dissatisfied. Since nurses are required to carry out as per the agreement with a patient and the family, one remains in a dilemma when to accept the demands of a patients family and when to deny.
The family of the patient required their demands to be known by only one health practitioners. According to the nursing principles, care is provided by an individual who works with others as a team (Lachman, Swanson, & Winland-Brown, 2015, p. 365). The work of a nurse in the provision of care should be well documented to ensure the person taking over care after their shift can understand the condition of a patient. Nurses should work closely as a team for assured quality care when a patient is a hospital and sharing of information is inevitable. It is also against the nurses principles to withhold patients information from another practitioner and hence leads to a dilemma.
The issues facing offering of care to the patient result in several alternatives that can solve the problems and minimize the risks that the nurse may face. First, the nurse can talk to the family members and show them dangers of lying to the patient. Secondly, in sending of the patients information to the family members, the nurse can make a call and to find out who is having the phone that time and they send the information. Also, they can decide to send an email to the family with the contents encrypted to ensure that the person who opens is the person who has the password to the document. Thirdly, the nurse can find out the spiritual beliefs of the patient and used them to comfort him at the end of life pains and in ensuring that the patient becomes old in making a decision on the treatments they will undergo.
Effects of Spirituality in Care
One spiritual believes is important in times of pain and distress resulting from sickness and especially in the last moments of the end of life. As a nurse practitioner, the use of spiritual belief in comforting patients is very powerful as they feel the compassion in the nursing care, and they feel as if one is sharing the pain through the period of sickness. The belief in supernatural giving many patients some form of comfort and this give a nurse practitioner a reason of sharing with the patient spiritual beliefs to ensure they feel at peace in the process of the care. Spiritual belief if applied in nursing care helps patients in avoiding taking actions associated with despair, depression and giving up in life (Yilmaz & Gurler, 2014, p. 942). Spiritual beliefs assist nurses to show patients that there is still meaning of life even after they undergo a treatment process that a patient may find difficult to accept such as when one will lose their legs of part of a body. The use of spirituality helps in enhancing the recovery process as it reduces the worry of a patient as it reduces the post-treatment depression and failure to see a meaning of life. Patients who are influenced by spiritual belief tend to have less behavior of resisting some treatment process. Hence nurses use it to convince them to accept and follow all the expected treatment procedures.
Comparison of Actions Taken With Decision-Making Model Recommendations
When using the decision-making model, some of the decisions made on the ethical dilemma issues arising from would be similar, but others are different from the identified alternatives. On the sending of the short messages to the family members, it was declined, and the family members would be requested to visit the hospital for updates on the progress. On the other hand under the decision-making model, the alternatives for the dilemma would have been to call the family and deliver the message over a call after ascertaining the recipient is the family member appointed to receive the information and decline the request (Suzuki, Ota, & Matsuda, 2014, p. 541). The first alternative of the model would bring different results to the adopted decision, since the family request would be granted partially and hence more satisfaction.
The family wanted their requests about their patient to remain a secret to one nurse; it was impractical because several nurses take care of the patient at different occasions. The decision made was same as the alternative put forwards in the model that the family was informed their request would be known to the team. On the information to be given to the patient, the decision was to tell the patient the truth and look for ways of letting them face the situation courageously with the most suitable nursing care. On the other hand, the model would have led to a similar decision where but with a little easier because of defining the goal in the initial stages of the issues faced. The model would also present other alternatives that could have been considered such as granting the family wishes to ensure that are satisfied and withholding some of the information from the patient, but revealing it to the family members.
Burkhardt, M. & Nathaniel, A. (2013). Ethics & issues in contemporary nursing (4th ed., pp. 161-172). Cengage Learning.
Byrd, G. & Winkelstein, P. (2014). A Comparative Analysis of Moral Principles and Behavioral Norms in Eight Ethical Codes Relevant to Health Sciences Librarianship, Medical Informatics, and the Health Professions. J Med Libr Assoc, 102(4), 247-256. http://dx.doi.org/10.3163/1536-5050.102.4.006
Kim, Y., Kang, S., & Ahn, J. (2012). Moral Sensitivity Relating To the Application of the Code of Ethics.Nursing Ethics, 20(4), 470-478. http://dx.doi.org/10.1177/0969733012455563
Lachman, V., Swanson, E., & Winland-Brown, J. (2015). The New Code of Ethics for Nurses with Interpretative Statements (2015): Prac...
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