Many of the pieces of information needed to assist Marianne’s family in making decisions in her care were included in the case study. The first thing we would need to know is if Marianne has a plan in place in case of a situation like this such as a living will or advance directive. Sometime’s people make these plans without the knowledge of their family knowing and leave it in care of a primary care manager or a family lawyer. I would first ask to look for these papers, to make sure one does not already exist. The family may need to set down with a mediator and try to come to a mutual decision in her care.They need to ask them, if she were sitting here, what do you believe that she would want.
The family needs to be made aware of all the options available and probable outcomes, should they decide to go fourth with the surgery or not. The ethics committee may appoint someone to help the family come to an agreement on the treatment plan of the patient. Other questions that should be answered is, what is the patients quality of life going to be if the surgery is done, what is the impact of the patients prognosis going to be on the family, do they have the means of providing long-term care if the patient cannot function the same after the surgery.These are hard decisions for any family to make, but when given the bigger picture, sometimes the decision becomes easier for the family to make. Red cap: How might family members’ values and morals affect their decision-making process when faced with potential end-of-life decisions for a loved one? The family member’s that are involved in making the decision in of end-of-life care for their loved ones can be caused by guilt. Many times the family states the feeling of guilt if they do not try everything possible to save the life of their loved one, despite the prognosis.
Depending on the religious affiliation of the family or family member making the decision, they may be even further conflicted on rather it is their place to make that decision and it being “right”. Many family members feel that they owe everything to that family member to keep them alive despite the quality of life it may leave them with, because that is what is owed to them, especially when it is an adult child making the decision for a parent. Rather it is personal values or religious values, many family members do not want to be the one that makes that ultimate life decision.Black cap: Discuss ways in which nurses can integrate concepts found within the American Nurses Association’s Code of Nursing Ethics and the Nursing Practice Act when caring for patients and their families.
Morals and ethics are what make’s ethical decisions. Standards as nurses that we should follow are nursing codes of ethics, which is ethical principles shared by a group, reflecting their moral judgments over time and is a standard for professional actions. .A nurse’s commitment is to the patient and/or family. Ethically, we rationalize our thinking.
It’s not based on emotion or intuitions. Components of ethical decisions are: 1) facts of the specific situation, 2) ethical theories and principles, 3) nursing code of ethics, 4) the client’s rights, 5) personal values, 6) factors contributing to or hindering one’s ability to make a choice such as, cultural values or lack of experience. (Blais, Hayes, 2011, p. 61). Nurses can serve on institutional ethical committees.
Ethical committee’s review cases, write policies and guidelines, and provide education and counseling. Ethical committees make ethical rounds, sometimes at the bedside ith the patient and family to discuss their case.Nurses should be an advocate for the patient. To be an advocate in a healthcare situation such as, Marianne’s case, you need to be assertive, respect patient’s rights and values, and make sure patients are aware they should make their own healthcare decisions. The risk involved if you do not follow ethical decisions, is using your own values and morals to help patients is unethical.
This may cause conflict between nurse and patient. Upon admission to a hospital or emergency room, the nurse should assess if the patient has an advance health directive.This is used to specify their wishes for healthcare decisions. There are three types; a living will which allows patient to omit or refuse medical treatment in the event of terminal illness, unconsciousness, or vegetative state. Durable power of attorney allows patient to appoint a surrogate or proxy to make medical decisions for them when unable to.
Also medical or physician directives can apply to any illness or injury when a patient is incapacitated. Under the Nurse Practice Act, a nurse may be charged with malpractice.To be charged with malpractice you have to assess if standard of care was not met. Standard of care reflects a basic minimum level of prudent care based on the ethical principle of nonmaleficence (“do no harm”).
Nurses are responsible for determining whether standard of care is met, not practitioners from other disciplines. Nurse expert witnesses are hired by each side that will testify as to whether or not the prevailing standard of care was met. Malpractice is not limited to what a nurse does (commission), but what a nurse fails to do (omission) in a situation. ”(Chitty & Black, 2010, pp. 83-84). Yellow cap:How might the family benefit from conversations with their loved ones’ health care providers and spiritual advisor during their periods of stress? The challenge of the health team is to provide care and compassion while maintaining professionalism.
The professional should be factual and truthful in order to maintain reliability and credibility amongst the patients ‘family. The health care team should, address the critical situation, and if questioned, discuss the possible chances of the outcome without ever giving up hope and most of all faith. Being too factual may deter the patient/family/healthcare worker relationship.Positivity is something that is grasped for in these situations, at the same time, families rely on the HCP to bring them down to earth even if it is something they do not want to hear.
According to Cabot’s (2012), “The nurse plays a crucial role in helping to initiate and maintain conversation about end-of-life care for patients and their families due to the ability to develop a more personal relationship with patients. ” In a situation where the family is at odds in determination of care, turning to spiritual advisors may be beneficial. Different religious denominations may be on call and can meet with the family.A pastoral care representative may have a deeper understanding of the patient and the family’s religious focus in the decisions that need to be made.
This decision making process and could ease the family’s concerns. Spiritual advisors can be instrumental in many instances. They can reinforce and remind the patients’ family of the wishes previously expressed. Acknowledgement of the grieving process and reinforcement of the love shared by the patient with her family in previous more vital instances may assist the family members in denial, in working through the process of grief. Green cap:Describe how ethics committees can provide support to patients’ families during their difficult decision-making process Ethics Committees are multidisciplinary committees created to assist with ethical dilemmas in institutional settings. They serve to provide input in review of situations of conflict with impartial, independent, recommendations as needed.
Ethics committees are advisory in nature and their decisions are not final, material (1985). However, with the leverage of the scope of expertise, their recommendations often resolve the concern or at least settle most of the concerns the patient and health care team may have.If there is an ethical problem involving the care of a patient, the ethics committee may be called upon to address the situation and together, make a consensus or recommendation. This does not always mean it will be accepted by the party in question, but often, due to the nature of their background and credibility, it assists with the patient and families’ decision-making process. Blue cap: How do you see your own morals and values affecting your feelings regarding difficult decisions for end of life care? Morals and values come into everyone’s ethical decision making process.In the case of a family that has two different distinct ideas, one to do all and the other to consider only comfort, the nurse and committee has to put on a ‘hat’ to detach from the outcome and support the surrogate decision maker and family involved(“Ache.
org. ”,2009). According to “Ache. org” (2009), “The traditional value to preserve life by all possible means is now being weighed against patient-centered, quality of life considerations based on evidenced-based care and a shared decision-making process” (Decisions Near the End of Life).As a nurse adheres to the Nursing Code of Ethics, there is a personal responsibility to allow it to guide and formulate decisions for end of life. Murray (2010), “While the Code of Ethics encourages nurses to remain consistent with their own personal values, it also emphasizes the need for open discussion of differing ethical principals in a manner that does not consistently plan one principal over another, thus avoiding the dangers of moral arrogance and moral certitude” (Moral Courage in Healthcare: Acting Ethically Even in the presence of Risk).
This is the foundation of discussion from the members of the committee. The decision of collaboration with varying morals and values balances the field of decision to arrive at a supportive, peace-driven statement for the patient and family. In this case, it is an end-of-life decision where there is no point of return. The gravity of it is deep and the emotions run deeper. During the process of reflective thinking and outcome based information, the groundwork of the committee’s moral and ethical values is laid.Feelings are turned into objective ideas so the family is empowered and emotionally supported.
Personal feelings are left outside the door with full respect of patient rights and probable outcome discussed inside. “The process of critical thinking by the nurse is driven by the patient and family” (Chitty & Black, 2011, p. 173). The goal is to bring a supportive position and point of care to the patient and family. When one walks out the committee room, each has a resolve that the decision reached is “for the inherent worth and human dignity of every individual” (“Ache.
org. ”, 2009).
