Application of Bioethical Model to Clinical Situation

Choose a patient-care situation in which the RN should intervene and advocate for the patient. An example of such a situation might be when a patient has not been given complete informed consent. Include the following in your paper: Describe the clinical situation concisely and descriptively. It can be an actual situation or a hypothetical one. Apply the Bioethical Decision Making Model to the specific clinical ethical situation that you choose. Address each section of the model in your paper. Conclude with a discussion of nursing advocacy in the clinical setting and the nurses role as a patient advocate. Your paper should be 4-5 pages. You must reference and cite 1-2 scholarly sources other than your text. Include a title page and a reference page to cite your text and adhere to APA formatting.

Answer

Application of Bioethical Model to Clinical Situation

Ethics are important for nurses because they allow nurses to navigate difficult work situations. The ethical guidelines are a moral compass that nurses use to do their jobs fairly and promote high patient care and attention (Berkey et al., 2018). The ethical guidelines also act as reminders of nurses’ commitment to society. It requires that the nurses continue with learning and encouraging evidence-based practices.

Bioethical Decision-Making Model

Define the Dilemma

I once had a 70-year-old patient who was diagnosed with cancer. At the time of hospitalization, the patient’s children requested that we tell them the diagnosis first so they could comfort their mother. The symptoms of the breast cancer had been apparent, and the children were already suspecting a cancer diagnosis would be made. Since the patient had mentioned to me in passing that a cancer diagnosis would probably be the worst thing that happened to her and she would not be able to fight through chemotherapy and radiation, the idea was good. First, the children would be informed, and then the doctor would tell the patient in the presence of the children. However, when the doctor informed the patient, her sons kept interrupting and making it difficult to communicate with the patient. They also requested her to be discharged, stating that they would seek a second opinion from other physicians.

Identify the Medical Facts

Since the patient has a painful lump on her breast, a biopsy was done to extract the core of the tissue for testing. Statistics show a 5-year survival rate for women with non-metastatic invasive breast cancer is 86% (McCabe et al., 2018). For breast cancer, early diagnosis is critical. The recovery of an individual from cancer depends on the size of the tumor, the number of lymph nodes that have cancer, and the tumor that impacts how fast the tumor will grow. Therefore, it is difficult to estimate an individual’s survival, especially at the first stages of diagnosis. The patient was at stage III of breast cancer since there was evidence that the tumor had been found in up to nine lymph nodes under the arm and the collar bone (McCabe et al., 2018). At this stage, out of 100 people with this stage of breast cancer, 86 will survive for five years with treatment.

The Non-Medical Facts

The sons stated that she would die much faster if the mother were told of the cancer diagnosis. The mother was born in Kenya, and due to the lack of proper medication, late diagnosis, and lack of funds to get better treatment, patients with cancer rarely survive. In many cultures, the family makes medical decisions for one of the sick members. Therefore, while the patient’s autonomy and full disclosures are favored in western medicine, the families choose what to tell the patients in African cultures. In these cultures, grown children have to protect their children. In most cultures, the physicians must first inform the family of the cancer diagnosis.

Identification

The patient, in this case, is an adult who is of sound mind. She can make her own care decisions, although her children think telling her may worsen her current health situation. However, if the patient does not know her health issue, she may not consent to some cancer treatments. She may also not be able to join experimental treatments that could prolong her life and help her beat cancer. The complexity of the culture between the western physicians and nurses and the patient’s family leads to an ethical dilemma of what should be done (Laryionava et al., 2018).

Underlying Ethical Principles

The main ethical principles that apply in this case include autonomy, nonmaleficence, and veracity. Veracity requires that healthcare providers are honest in their interactions with patients. It is morally wrong to lie even when the lie produces better outcomes (Berkey et al., 2018). Nonmaleficence requires the nurses not to harm patients intentionally. Nurses need to provide a standard of care that avoids risks and increases medical competence. Autonomy allows the patients to make independent decisions (Ghoshal et al., 2019). The nurses need to ensure patients have all the information they need to make the right decision on their medical care and are educated.

Alternatives and Follow-Up

The best course of action is to educate the sons on the importance of allowing patients to know what they are fighting. This will allow the patient to make the right choices regarding their treatment. The patient will eventually catch on to the lay since she will need to undergo chemotherapy treatments to shrink the tumors. If she finds out on her own, she will feel overwhelmed and betrayed (Ghoshal et al., 2019). However, providing patient education will allow her hope for recovery and understand all the treatment and care processes recommended by the doctors.

Nursing Advocacy in the Clinical Setting and the Role of Nurse Advocate

Advocacy is broad knowledge that has been used in various professional fields, not only in nursing. It means the ability of a professional to stand in the gap on behalf of their clients and plead to have their rights observed before any decision making. In the field of nursing, nursing advocacy means providing freedom from suffering, preserving human dignity, and promoting patient equality (Gerber, 2018). It is about empowering the patient and allowing them to get involved in decision-making concerning their health. Therefore, nursing advocacy provides effective care in a clinical setting and illustrates the nurse’s professional power. It gives the RN nurses power to stand by the patient’s interests and ensure their rights are preserved throughout the treatment process (Nsiah et al., 2019). In the clinical setting, the organization’s primary role is to ensure the facility is running and generates maximum profits. On the other hand, nurses must ensure patients are satisfied with the quality of care and promote the interests of the patient to the management of the facility. This way, they ensure that the organization meets the primary objectives of patient safety beyond making profits.

On the other hand, nurses play a critical role in advocating for the patient and respecting the different family dynamics. For instance, in this patient’s case, the nurse is responsible for ensuring the patient adheres to treatment, which includes ensuring the patient understands what they are suffering from (Gerber, 2018). However, the nurse should also ensure to respect the role of the family and how they require the patient to be treated. In this case, the family members preventing their loved ones from accessing information about their diagnosis is a way of protecting them (Nsiah et al., 2019). However, the nurse’s role is to ensure that although the family members protect their own from information, they guarantee the provided information is complete and accurate. Another nurse’s responsibility as an advocate is to ensure the patient receives quality care and adheres to medication regarding their information. As an advocate of the patient, the nurse is expected to provide critical information to the patient and their families and ensure that they are comfortable with their care.

 

References

Berkey, F. J., Wiedemer, J. P., & Vithalani, N. D. (2018). Delivering bad or life-altering news. American family physician98(2), 99-104. https://www.aafp.org/afp/2018/0715/p99.html

Gerber, L. (2018). Understanding the nurse’s role as a patient advocate. Nursing202048(4), 55-58.doi: 10.1097/01.NURSE.0000531007.02224.65

Ghoshal, A., Salins, N., Damani, A., Chowdhury, J., Chitre, A., Muckaden, M. A., Deodhar, J. & Badwe, R. (2019). To tell or not to tell: exploring the preferences and attitudes of patients and family caregivers on disclosure of a cancer-related diagnosis and prognosis. Journal of Global Oncology5, 1-12. https://ascopubs.org/doi/full/10.1200/jgo.19.00132

Laryionava, K., Pfeil, T. A., Dietrich, M., Reiter-Theil, S., Hiddemann, W., & Winkler, E. C. (2018). The second patient? Family members of cancer patients and their role in end-of-life decision making. BMC Palliative Care17(1), 1-9. https://doi.org/10.1186/s12904-018-0288-2

McCabe, M. S., Wood, W. A., & Goldberg, R. M. (2018). When the family requests withholding the diagnosis: who owns the truth?. Journal of Oncology Practice6(2), 94.

Nsiah, C., Siakwa, M., &Ninnoni, J. P. (2019). Registered nurses’ description of patient advocacy in the clinical setting. Nursing Open6(3), 1124-1132.https://doi.org/10.1002/nop2.307

 

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