Discuss about the Essay for Complex Clinical Situation.
This essay presents the state of ethical controversy arising from a complex clinical situation when an elderly patient in the RAC (Residential Aged Care Facility) experienced the episode of chest pain and eventually died from cardiac arrest during the process of her transfer to the emergency care unit. Despite the patient’s refusal of receiving treatment intervention in a medical emergency, she was transferred to the emergency care unit of the hospital and resuscitated by paramedic during the episode of cardiac arrest. Various legal and ethical discrepancies related to the case study discussed in the context of evidence-based literature and accordingly the appropriate defensible solution provided for combating these difficult scenarios.
The stakeholders in the presented case study include the registered nurse and paramedic who were deployed in the RAC (Residential Aged Care) facility for attending the elderly patient in the scenario of a medical emergency. Other stakeholders include the RAC facility, primary care physician as well as the family members of the elderly individual. The case study presents an ethical dilemma that occurred when the healthcare team attempted to save the life of the patient during the episode of cardiac arrest. In the absence of the accomplishment of the advanced care directive (ACD) by the patient, the registered nurse professional and paramedic facilitated the patient transfer to the hospital and administered the resuscitating intervention in the context of saving the life of the affected patient. The life saving intervention based upon the patient transfer and aggressive resuscitation administration was carried on in the best interest of the patient for her revival. Contrarily, aggressive treatment and transfer interventions were administered in the absence of the will and consent of the elderly patient.
Nurse professionals require accomplishing their moral obligations while undertaking the ethical challenges encountered during the course of clinical interventions to the treated patients (Zahedi, et al., 2013). However, nurse professionals also require practicing autonomy in taking independent decisions while encountering complex clinical scenarios. Evidence-based literature demonstrates the pattern of reciprocal relationship between the workspace constraints and the eventual adverse psychosocial outcomes faced by the nurse professionals across the clinical setting. In the presented case study, the registered nurse was bound to order the transfer of patient to the hospital setting under the influence of ethical constraints and healthcare protocols enforced by the RAC facility (Gaffney, DeMarco, Hofmeyer, Vessey, & Budin, 2012). Resultantly, the registered nurse faced legal charges from the family members of the patient in terms of the allegation regarding assault and battery that resulted in the death of the patient on arrival in the emergency department. Research findings by (Dyson, Bray, Bernard, Straney, & Finn, 2016) indicate the effectiveness of the out-of-hospital resuscitation by paramedics in terms of saving the lives of patients affected with the episodes of cardiac arrest. In the presented case study, the paramedic following the same convention with the objective of reversing the complications faced by the patient under the influence of cardiac arrest. Furthermore, practicing the appropriate medical interventions for reducing the deterioration in the clinical condition of the patient regarded as the moral and ethical right of the paramedic professional. The registered nurses as well as paramedic professionals continue to face the pattern of discourse related to the publication of healthcare guidelines and their implementation across the clinical settings (O'Driscoll, et al., 2016). In the presented case study, the patient never signed any ACD; however, she verbally refused the aggressive life saving treatment in case of medical emergency. This resulted in an ethical dilemma when she faced the episode of chest pain and cardiac arrest and eventually the RN and paramedic were left with no choice than to immediately transfer her to the hospital emergency while administering the resuscitation intervention during the process of transfer. The rights and dignity of the both RN and paramedic need significant consideration by the healthcare authorities while configuring any decision in response to the complaint filed by the family members of the affected patient. The findings in evidence-based research literature advocate the requirement of elevation of the dignity of registered nurse professionals and paramedics for improving patient care outcomes in nursing practice (Parandeh, Khaghanizade, Mohammadi, & Mokhtari-Nouri, 2016). In the presented case study, the dignity and rights of the members of healthcare team as well as the RAC facility remained at stake after the decision of the patient’s family members for suing the healthcare team’s members while making them responsible for the death of the affected patient. Resultantly, the diminution of the rights and dignity of the registered nurse, paramedic and RAC facility might affect the quality of healthcare services and medical decision making undertaken by them in prospective clinical scenarios.
The evidence-based findings by (Scheunemann, 2011) advocate the requirement of rationing while extending care and assistance of the patient population. Rationing emphasizes the need for selectively blocking the administration of treatment interventions to the patients in various treatment scenarios. In the presented case study, the concept of rationing was not utilized in the context of the fact that the patient could not sign the ACD while mentioning her unwillingness in receiving potentially lifesaving treatment in case of medical emergency. From the perspective of ethical convention, healthcare strategies require the administration in accordance with the desire and consent of the treated patient. However, the legislative convention does not allow medical professionals to refrain themselves in administering life saving healthcare interventions to the deteriorated patient in the absence of duly signed ACD mentioning the unwillingness of the patient in receiving aggressive treatment. Contrarily, the rule of rescue encourages healthcare professionals in administering life saving strategies to the dying individuals irrespective of the limited scope of benefit (Scheunemann, 2011). The principles of healthcare ethics describe the adverse influence of the moral strain and incongruence of values on the pattern of medical decision making and associated healthcare interventions for the treated patients (Gabel, 2011). In the presented clinical scenario, the registered nurse professional was unable to align her moral values with the perspectives and values of the patient and therefore, execute the decision of transferring the patient to the hospital under the influence of the moral strain. The act of the registered nurse professional proved unethical from the perspective that emphasizes the requirement of including the patients in their medical-decision making. The nurse professional required effectively communicating with the patient on an ongoing basis for evaluating her perspectives, contentions and cultural beliefs and could have informed the same to the RAC management in the context of taking an evidence-based ethical decision during the episode of patient’s cardiac arrest (Kourkouta & Papathanasiou, 2014). Contrarily, the lack of an effective therapeutic relationship of a registered nurse with the patient resulted in the unilateral decision of the healthcare team in transferring the patient to the hospital emergency while attempting to resuscitate her during the episode of cardiac arrest. The research findings by (Kim, Roth, & Wollburg, 2015) indicate the influence of a therapeutic relationship of the healthcare team with the treated patient on the pattern of his/her psychosocial outcomes. In the presented clinical scenario, the elevation in patient’s psychosocial outcomes following the nursing might indicate the improvement in the psychological state of the patient; however, this might not influence her decision of not receiving the life saving interventions in case of medical emergency. Therefore, analysis of the case scenario from this perspective indicates that the registered nurse professional appropriately utilized the conventions of professional practice while ordering the patient transfer under adverse clinical circumstances.
The code of ethics and professional conduct stipulated by NMBA (Nursing and Midwifery Board of Australia) advocates the requirement of administering qualitative healthcare interventions to the patient population (NMBA, 2016). The ethical code also signifies the requirement of treating the patients and family members with kindness and affection. In the presented clinical scenario, the registered nurse professionals failed to consider the treatment preference of the patient during a medical emergency indicates the absence of kind gesture of the healthcare team in dealing with the patient’s condition. However, the same convention also advocates the requirement of practicing safety measures for enhancing the well-being of the treated patient. Therefore, with this perspective in mind the nurse professional and paramedic rightly practiced the ethical norms while attempting to save the life of the deteriorated patient. The nursing code of ethics advocates the requirement of maintaining transparency with the treated patient while administering diagnostic and treatment interventions (Gallagher & Hodge, 2012, p. 79). However, in the presented clinical scenario there was no commitment between the medical team and the patient and her family members regarding the needful action in case of a medical emergency with the patient. Resultantly, the decision-making by the registered nurse and paramedic gave rise to an ethical dilemma. Evidence-based clinical literature advocates the requirement of practicing phenomenological approaches by the medical professionals while administering care interventions for the patient population in the clinical setting (Greenfield & Jensen, 2010). The ethical concerns embedded in the chronic conditions and adverse experiences of the affected patient require due consideration by the nurse professionals and paramedics while taking calculated decisions during medical emergencies. In the presented clinical scenario, the age of the patient and her chronic cardiovascular, psychological and musculoskeletal conditions proved to be the biggest hindrance in administering care and treatment interventions to the patient in the hospital setting. According to this ethical perspective, the registered nurse professional required evaluating the probability of patient’s survival while taking an evidence-based decision during the medical emergency. Furthermore, the absence of a thorough discussion regarding the end-of-life issues of the patient and her family members resulted in a conflicting situation where the registered nurse professional experienced ethical stress because of her incapacity of taking a moral decision during the episode of patient’s intense chest pain (Ulrich, et al., 2013). Resultantly, the decision of transferring the patient to the hospital unit was taken by the registered nurse professional with the sole objective of saving the life of the deteriorated-patient. Advanced care conventions for the elderly patient advocate the requirement of providing culture oriented care and therapy during the end stage of life (Kalra, Forman, & Goodlin, 2015). In the presented clinical scenario, the nurse professional as well as other members of the healthcare teams required undertaking advanced care planning for the patient while including her family members and primary care provider for surpassing any potential conflict related to the medical decision making during the end stage of patient’s life. The ethical decision making related to the cardiopulmonary resuscitation intervention by the medical teams requires the consideration of patient’s perspectives related to the life and death decisions (Hayes, 2013). Contrarily, in the presented clinical scenario the paramedic utilized the technical and legal perspective of decision making while administering resuscitating approach for saving the life of the patient during the episode of cardiac arrest (Hayes, 2013). This resulted in the ethical dilemma requiring intervention of the jurisdiction following the allegation by patient’s family members.
The legally and ethically defensible solution to the potential conflicts arising from the treatment decisions undertaken during medical emergencies attribute to the inclusion of the elderly patient as well as her family members while configuring advanced care planning and associated approaches. The nurse manager needs to evaluate and address the elderly patient’s chronic conditions; cultural background and associated conventions related to the treatment strategies that the patient aspires to receive while experiencing the state of deteriorated health. The configuration of individualized and holistic healthcare approaches requires strategic execution while prioritizing the perspectives of the treated patient in adverse circumstances. On the other hand, the medical teams also need to provide thorough explanation to the patient’s family members regarding the adversities the patient might face in the absence of the requisite resuscitation intervention administered with the objective of saving the life of the affected patient during the episode of severe conditions like cardiac arrest and respiratory failure. Indeed, the nurse professional, paramedic as well as other members of the healthcare team must effectively collaborate with the elderly patient and his/her family members while taking calculated decisions regarding the treatment methodology requiring administration to the patient during complex clinical situations.
The presented clinical scenario presented an ethical as well as legal dilemma arising from the decision undertaken by the registered nurse professional as well as paramedic in transferring the patient to the hospital while administering resuscitation intervention for saving her life during the episode of cardiac arrest. Various ethical and legal conventions require subjective consideration by the healthcare teams in caring for the elderly patients across the RAC facilities. Healthcare decision makers must configure holistic interventions and policies for assisting medical professionals in taking the most appropriate and valid decisions while tackling the medical emergencies experienced by the elderly patients.
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