Identifying And Addressing Ethical Issues In Palliative Care: A Case Study

Identify and describe a minimum of three key ethical issues within the case study.

Discuss how you will ensure that all your interactions with the client/family reflect ethical concepts briefly explain Nursing ethics.

How would you plan and implement two nursing interventions for each key ethical issue.

within the strategies, ensure that you demonstrate that you are abiding within legal and regulatory guidelines for EN (Div 2) practice.  Demonstrate that you understand the implications of current legislation and how they are incorporated into your nursing interventions.

To ensure the clients rights, interests and decisions are supported, identify and relate consumer rights and responsibilities to the three ethical issues identified.

To encourage the client’s rights to make an informed decision regarding their care, outline the major ethical principles and relate them to the three key issues in the case study.

Mr. Joseph Weber, aged 58 years, shifted to Australia after being detected with Stage IV of Mesothelioma. This disease had migrated to his hips, spinal cord and brain. He also had hepatitis B and suffered from last stage of cancer. He was admitted to the hospital under palliative care for further treatment. Mr. Weber could not speak and often during the treatment by the nurses, he used to lose control and hit the nurses. It was suggested by the nurses to tie up his hands. He was also neglected on account of his body weight against the linen and mattress. His skin had turned red and the deterioration had started. He is supposed to be moved and turned around but that was not done due his shouts of agony. Mr. Weber’s sister protest about the inadequate care an a overdose of medicenes. Upon the commanding of opioid medication for his treatment, the doctor talked about the life care stopping with skin morphine medication with his family. His family confides with the doctor by letting him know that they want to free Mr. Weber of the excruciating pain and gift him a painless death. Mr. Weber’s children, Zac and Joanne share powers of attorney upon health and financial matters. Presently, Mr. Weber has declined all kinds of treatment.

Identification of 3 key ethical issues:

After studying the facts of the case, the major ethical issues that crop up are discussed below:

Due to the excruciating pain suffered by Mr. Weber out of the mesothelioma and hepatitis B, there can be chances whereby he can lose his temper. The will to live and ethical behavior vanishes in front of the intensity of the pain. Moreover, he had become non verbal. Hence, his attacking the nurses during the treatment and his violence is justified. But suppressing his hands is a sign of unethical behavior and becomes humanity on the part of the nurses. Since they are trained to deal with patients, it is unexpected that they such activities. This will increase the pain of the patient and will to struggle with the pin would disappear (Bevans & Sternberg, 2012).

The nurses can have a conversation with the family of the patient to speak to Mr. Weber about his violence. It would be feasible for them to make him understand, rather than the nurses, that the nurses are doing their duties. The nurses should explain that letting the nurses complete their duties would put him in a more comfortable state and free him from pain. Hitting on the nurses would a hurdle in his treatment. The nursing staff would bring in more staff who possess experience regarding this matter. Nurses who are patient and not very tough on the patient should deal with Mr. Weber to deal with the issue. The suppressing of his hands would not be the right solution. These methods are completely legal and is based upon the present legislation. Giving of  mild anaesthesia or other drugs, prescribed by a specialized doctor during the nursing intervention would also be legal. Over dosage should be strictly prohibited (Crist & Grunfield, 2013). Stringent action and regulation should be given to prevent such an issue lest it could lead to other side effects.

Identification of 3 Key Ethical Issues

However, the above should be done only after the permission of the patients family. The dosage should abide with the regulations otherwise the clients can issue their consumer rights. The client should be well informed by the nurses, about the results and possibilities of such usage. Before the implementation of such procedures, the interests o the clients should be known. The nurses should not hide anything from the consumers (Zahedi et al., 2013).

The next key ethical issue under the case study is when Mr. Weber is made to lie on the bed. The linen and the mattress of the bed causes discomfort to him. A kind of bed soar is happening to him but there is negligence. There is prescription that should be turned around after a span of every 2 hours. Due to his infirmities, his skin has become dilapidated. He has become very lean and his bones and muscles have lost their luster. He has become a bony structure. This is the main reason he should be turned around after little spans. His skin has become red and they are breaking down. But the nurses do not do much to help him (Dante et al., 2011). Since he is unable to bear the agony, he cries and whimpers a lot. The nurses, consequently don’t come and turn him around. They are being negligent towards him. Rather, the nurses are under the impression that if they go to aid him he would shout more. This is unethical. They are not giving their best to serve Mr. Weber. This unethical behavior is just aggravating the pain and causing more discomfort for him. His bed soar is increasing and spreading to the other parts of the body.

In this matter, the nurses should be more vigilant. It is the duty of the nurses, to take special care for the serious patients. The adequately trained nurses should be allocated for the purpose of decreasing this pain. Despite the patient’s continuous scream, they should be efficient enough to perform their duties. The patient should be turned after every 2 hours. The skin should be cleaned, medicated and maintained in the most hygienic ways. Then only the disease could be prevented. The nurses should interact with the family members so that they too can cooperate in this matter. They could explain to the patient about the importance of the treatment and it would give him peace. The nurses can implement ways of distraction for the patient so that his attention is diverted towards a recreational activity while the nurses do their tasks (Kim & Bates, 2013). This would give him lesser pain. With the incorporation of these measures, the involvement of the nurses could be increased and for the betterment of the patient. These ways are absolutely legal and are abided by the latest statutes. The family of the patient should be made aware of the status of the patient’s health. In case of new treatments to be started by the nurses, prior consent of the family should be taken. Every little step should be at par with the consumer rights.

First Issue: Suppressing Patient's Hands

The third ethical issue which has been laid stress upon in the case study is, the absence of the adequate care which is to be given to serious patient. Mr. Weber’s sister had also protested against over dose of medications. the nurses had a tendency to ignore him because he always groaned in pain. In order to keep him quiet and not get disturbed themselves, the nurses gave medicenes, which resulted in the usage of more quantity than prescribed. This over dosage could result in further deterioration in his health. Moreover, the desired care was not given to him. He was neglected many a times. The timely care was missing. This is sheer unethical behavior on the part of the nurses. This also means a breach of their duties and commitments to patients. When patients are under palliative medication, it means their end is near (Morrison & Korol, 2014). They would not live ling but the time during which they are to survive, they should survive in peace. With the help of the medication, the pain is ceased temporarily. The nurses do not take care of him as required to be done for such a serious patient like Mr. Weber.

The nurses should incorporate more skilled and efficient staff. The more skilled staff would be able to cater to the needs of the patient and their high degree of care. The medications should be given from time to time. The exact quantity of medicenes should be provided, as prescribed by the doctor. The hygiene of the patient’s health should be maintained by the nurses. This helps in the prevention of capturing more disease. Since the patient is weak, the adequate nutrition should be provided by the nurses with complete care (Schluter et al., 2011). The nurses should interact more with the family members of the patient so that the family too could aid in the patient recovery. The members of the family should persuade the patient to listen to the nurses and convince them to cooperate with the treatment. This would in turn, benefit the patient’s health to a greater extent. While incorporating new modes of treatments and strategies the previous consent of the family is essential. The family should be aware of the ways their patient is being treated. Their wishes should also be given importance. The nurses should follow the existing rules and regulations prescribed for the patient in accordance with the latest statutes. The methods should be legal and scientific. The consumer rights and obligations are applicable upon the service of the nurses. In case of a breach of duty, the family members of the patients can refer to the consumer forum for the adequate relief (Por et al., 2011).

Thus, the unethical behaviors from the nurse’s side should not be encouraged. The nurses should follow their codes of conduct and ethics. They should be dutiful in serving all the patients that come before them.

References

Bevans, M. and Sternberg, E.M., 2012. Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. Jama, 307(4), pp.398-403.

Crist, J.V. and Grunfeld, E.A., 2013. Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psycho?Oncology, 22(5), pp.978-986.

Dante, A., Valoppi, G., Saiani, L. and Palese, A., 2011. Factors associated with nursing students' academic success or failure: a retrospective Italian multicenter study. Nurse Education Today, 31(1), pp.59-64.

Kim, J. and Bates, D.W., 2013. Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), pp.590-598.

Morrison, K.B. and Korol, S.A., 2014. Nurses' perceived and actual caregiving roles: identifying factors that can contribute to job satisfaction. Journal of Clinical Nursing, 23(23-24), pp. 3468-3477.

Por, J., Barriball, L., Fitzpatrick, J. and Roberts, J., 2011. Emotional intelligence: Its relationship to stress, coping, well-being and professional performance in nursing students. Nurse education today, 31(8), pp.855-860.

Schluter, P.J., Turner, C., Huntington, A.D., Bain, C.J. and McClure, R.J., 2011. Work/life balance and health: the Nurses and Midwives e?cohort study. International Nursing Review, 58(1), pp.28-36.

Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., Maddah, S.B., Cheraghi, M.A., Mirzabeigi, G.H., Larijani, B. and Dastgerdi, M.V., 2013. The code of ethics for nurses. Iranian journal of public health, 42(Supple1), p.1.