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Decision-making Models: Nursing Ethics

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Questions:

A 6-year-old develops a high fever accompanied by violent vomiting and convulsions while at school. The child is rushed to a nearby hospital. The attending physician makes a diagnosis of meningitis and requests permission to initiate treatment from the parents. The child’s parents are divorced. The mother, who is not the biological parent of the child, has primary custody. She is a Christian Scientist who insists that no medical treatment be offered for religious reasons. The biological father, who resides in another state, is also contacted. He insists that treatment be given and seeks independent consultation from another physician.
Assignment:
1. What is the ethical dilemma here?
2 .Describe the decision-making model you selected from your readings.
3. How would you resolve this dilemma using the model?
4. explain your decision to the family.

 

Answers:

1. According to the given details in the case study, the patient is a minor; therefore, parental consent is important for medical proceedings. The primary concern for the doctors and nurses in the healthcare arena is taking care of the patient is to provide her care, support, comfort and medical help at the earliest (Holloway & Wheeler, 2013). The ethical dilemma here is that while the patient needs immediate medical care, the opinion of the parents is differing. Leaning on her religious and spiritual belief, the mother, who is not the biological mother of the child, is opposing any treatment while the father who stays away from the child, is asking for immediate attention. Should the decision be based on the mother and her idea of the situation, the child's health might suffer, but since she is the local and legal guardian and the parents are divorced, the father's concern cannot be regarded as important as the mother's. Here the nurse can intervene to maintain the sovereignty of the healthcare system which aims to put patient's health first and can advise both parents to come to a conclusion as fast as is possible for the betterment of the child (Chandra et al., 2013).
 
2. A proper decision making model can solve the problem or proceed towards a probable solution. Here Uustal's decision-making model is being used (Uustal, 2013). There are several steps included in the model (Armiger, S. B. 2013). The first step is recognizing the ethical dilemma. The ethical dilemma here is whether to put the child's health first or to consider the parent's differing decisions. Then ethical position and personal values are considered. The ethical position is unbalanced and unresolved, the personal values of each parent are considered for relevancy. Here the mother is religious, and her spiritual leaning is guiding her decision to disallow medical attention towards the child. The father, on the other hand, is interested in providing the child with the best healthcare and looking for the second opinion. The next step involves Alternative resolution and alternative course of action (Grace, 2013). Each course of action is discussed in full detail so come to a conclusion. In the next steps credibility of the possible outcomes is considered in brief detail, the acceptable alternative is taken into account, and a plan of action is created accordingly. The plan is then implemented, and the results display evaluation of the plan (Korhonen et al., 2015).

3. Using the Uustal’s model this ethical dilemma can be solved. The first step is to explore the issue and understand the viewpoint of both parents and the healthcare professionals. The second step is to find a common ground and offer the alternative resolution (Butts & Rich, 2012). In this case, the common ground is the child's health and ultimate well-being. Both the parents are concerned about the same and so, their decisions may be molded to serve the patient better. Based on the alternative resolution, an alternative plan of action can be discussed. Here, the patient can either be left untreated or given the best medical treatment available. There can be four possible outcomes, either the patient gets well after treatment or the patient deteriorates after the treatment or the patient deteriorates due to the lack of treatment or the patient get’s well in spite of the lack. The only two acceptable conditions are either the patient gets well with treatment or the patient gets well without treatment. Both leaning on facts it can be stated that the only approach suitable for the healthcare professionals is to provide the 6-year-old with medication for meningitis. After implementation of the plan, the results are noted. The credibility of the plan depends upon the rate of success (James et al., 2014).

 

4. The nurse (to the parents): I would like to discuss the patient’s condition and the probable treatment routes for her fast healing.

The mother: Treatment plans? I cannot allow this. She will get well on her own; just make her comfortable.

The father: We can, and we should talk about treatment plans. I want her health restored as soon as is possible.

The nurse: I understand and respect both of your concerns. Let's sit and talk and if you want, we can have this conversation with the doctor too.

The mother: Okay, let us talk but I will not let you guide me away from my religious beliefs.

The father: Yes, Let’s talk.

(After sitting down for a talk)

The nurse: You know your child has high fever, she has been vomiting continuously, and she is having periodic convulsions. Let me tell you the truth; she is deteriorating. Since she is a minor, without your consent, we cannot treat her.

The father: But I am giving the consent.

The mother: Is she that bad?

The nurse: Yes, she is, and no your consent alone is not enough. There are two acceptable scenarios. Either she gets well without the treatment or she gets well with the treatment. We all know that chances of her getting well without the treatment are low to none. I do not think you will like to take those chances because it might put your little girl's life in danger. As healthcare professionals, we cannot withhold treatment but in this case, we cannot proceed without your help. Please do give us the consent so that we can offer all the assistance and the medical support your little girl needs.

The mother: Yes, okay. You have my consent.

The father: Yes, please hurry and give her the treatment. You have my consent.

 

References

Armiger, S. B. (2013). Ethics in Nursing. Should the Patient Know the Truth?: A Response of physicians, nurses, clergymen, and lawyers, 120.

Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.

Chandra, A., Finkelstein, A., Sacarny, A., & Syverson, C. (2013). Healthcare exceptionalism? Productivity and allocation in the US healthcare sector (No. w19200). National Bureau of Economic Research.

Grace, P. J. (2013). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Publishers.

Holloway, I., & Wheeler, S. (2013). Qualitative research in nursing and healthcare. John Wiley & Sons.

James, S. R., Nelson, K., & Ashwill, J. (2014). Nursing care of children: Principles and practice. Elsevier Health Sciences.

Korhonen, E. S., Nordman, T., & Eriksson, K. (2015). Technology and its ethics in nursing and caring journals An integrative literature review. Nursing ethics, 22(5), 561-576.

Uustal, K. M. (2013). Implementation of a Nurse-Driven Mobility Protocol in Critical Care.

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