I remember, she arrived on our unit looking very sad. She was 35 and had a husband who was with her and two children. The children were in the waiting room with grandma. She was here to have a total hysterectomy because they had recently found ovarian cancer. She had a long haul ahead of her as she was to get chemotherapy and radiation after surgery. She looked very frightened as well as sad and her husband was pale with worry. The children did not seem to know the seriousness of the situation but grandma's face showed her fear and concern.
As nurses we know that ovarian cancer still does not have a great statistical improvement in outcome so empirically, nursing is aware that this patient may not do well. The fact is that ovarian cancer is the leading cause of death from gynecologic malignancies (Timbly & Smith, 2007). We also know from experience that hope can be a major factor in recovery where recovery is possible. We take this empirical knowledge to the bedside with us when we approach.
An alertness to the circumstances and an examination of the social context is important (Beauchamp & Childress, 2002). In this case, I felt like she needed to see her children before surgery and children were not supposed to come back to the suite but in this case, I convinced management to allow us to do that. It was the "right thing to do" and it made a difference to this patient. I also helped her to remember why she wanted to do well when she arrived in surgery.
This young patient had some very difficult decisions to make after her surgery as she was in stage four. My job ethically at this point was to assure that she got all the moral support that she needed to help her make the right decisions for her, as well as her family and that no one was able to put her in a situation of making a decision based on their needs and beliefs instead of hers. The emotional response from the nurse here is very important also as emotions play an important part in our ethical lives.
In this particular case, the esthetics and ethics part of caring are intermingled as both have much to do with the patient and her family and their needs as a whole. In these cases nursing must do what is necessary to assure that families are able to provide each other the support that is needed and this mother needed to see her children for several reasons but most of all to assure her of her reason to live. Personally, in this case, we all know how we might feel if we were in the same circumstance. This helps us to empathize with the patient and the family.
It also brings some of the personal feelings we have had in dealing with other patients with this illness and how they did at the time. Being involved in a case like this is very important and a patient in this circumstance would know immediately if you were detached and did not care about her situation. This kind of case immerses the nurse in this patients care. Nursing is empowered to provide for this patient on several levels. Allowing this patient to take some power in the situation that she is in is important and nursing can help her with that under emancipatory caring.
There is no justice in a diagnosis like this under these circumstances but the nurse can help this patient and herself find a middle ground which will give the patient some equity in her decision making. In this case the patient made the decision after her surgery to do the chemo but not the radiation. Was it the right thing to do? Only she can know that and she was allowed the power to make that decision which empowered she and the nurse, as well as her family who stayed involved in this care.