Ethical dilemma can be very dangerous in medical field and it can affect the natural balance of the workplace (Sherwood & Zomorodi, 2014). In this case, Jade, is a newly graduated RN and in the workplace she was in her second week of new graduate program. In the very beginning of her working for that day, she faced a dilemma regarding the condition of an 11 year old Acute Lymphocytic Leukaemia patient. The dilemma associated with the patient made Jade upset at the end of the day due to her decision as others were blaming it. The purpose of this paper is to discuss how ethical dilemma in medical terms create problem among the medical duty holders and how the patient are affected with the outcome of it. The paper will illustrate the dilemmatic situation in detail and the roles and duties of nurses to deal with such issues will also be described thoroughly. Finally, the paper will provide some recommendations for the situation. However, the appropriate treatment procedure for this patient is beyond the scope of this paper and hence they will not be discussed.
Ethical and medico legal issues
Ethical and legal issues in medical field are common but potential ethical issues should be thoroughly and carefully examined in order to avoid further dilemma and other hazards. Nurses as well as doctors need to work within a complex web of ethical as well as medico legal issues (Clarke & Knights, 2015). Nurses need to accomplish some legal implications while dealing with the issue of any patient. Furthermore, nurses are always bound to uphold the duties, responsibilities, principles and foundational moral virtues that during their practice in nursing profession. Ethical issues can arise anytime and it always affects the decision making process by making it more complex (Holm & Severinsson, 2014).
Clinical decision making
The decision of nurses always has important contribution in the health outcomes of the patients. In the theoretical framework of clinical decision making process, complex decision process in broken down into some smaller subcomponents and each of them can be subjected to validation and experimentation. Clinical decision making process requires collecting sufficient amount of data and information about the patients’ health status. Clarity and communication is the main key factor of a successful decision making process (Meyers, 2016). In this case, Jade is also bound to have a clear and detail communication with the fellow workers and doctors, while working as a team and highly essential in making any decision regarding the patient’s health.
Interdisciplinary teamwork and leadership
Across the healthcare department, the interdisciplinary issues in teamwork can be the barrier in patients’ care. Teamwork failures accounts to most of the medication errors as well as unfruitful decisions in the healthcare. A well-formed teamwork always offers to improve clinical care as a variety of knowledge and ideas can be applied in making decisions. A team of healthcare professionals ideally work to determine diagnoses, planning care and evaluating the plans. While working as a team, all the team members are bound to inform other members about any decision and with the consent of all the members any final decision is taken. If any individual tries to take decision individually then that causes to a massive teamwork failure and ruins the leadership quality also as a leader of a team also cannot take decision individually without informing others (Clarke & Knights, 2015).
In this case, Jade was a newly registered nurse and she was not so much familiar with such kinds of ethical dilemmas (Prinsloo & Slade, 2015). Jade became surprised when she heard that Bethany, the patient did not receive any medicine or even IV line or antibiotics for which she was written up by the doctors due to her mother religious belief of not receiving any medicine (Prinsloo & Slade, 2015). When she was suggested by the doctors to provide medicine to the patient without informing her mother, she did not listen. Even, she also disclosed the plan of the doctors about taking custody of the patient to the mother. Also, without informing the leader, being a new registered nurse, Jade cannot take any decision alone.
The most important thing to be remembered being a nurse is to maintain the dignity and trust with the patients and their family members (Ganz, Wagner & Toren, 2015). Nurses are responsible to provide high quality care to the patients by maintaining the work ethics and value as well. They undoubtedly confront various challenges and issues while dealing with different kinds of patients (De Vries & Plaskota, 2017). But, they should be familiar with the ethical codes while handling the medical challenges related to the patient parties. Nurses always work in a fast-paced environment where they need to take many quick decisions and if the decisions are not fruitful then they also face many kinds of vulnerabilities from the patient parties and which affects their career also (Smebye, Kirkevold & Engedal, 2015). At the same time it affects the reputation of the healthcare organization. So, all the nurses maintain ethical standards while dealing with the patients. Patients also depend on the nurses’ ethical standard. The main duty of RN is to build trust with the patients and their families so that they can leave their patients under their intervention without having any confusion. Codes of ethics are the fundamental guidance for all the nurses and they are bound to maintain that while taking care of any patient. Nurses always maintain their professional competency by participating in the professional development of the healthcare organization. Even, according to the code of ethics of the nurses, they are not only bound to provide care for the patients but also for their families and all other associated groups (Dwarswaard & van de Bovenkamp, 2015). It is being stated that sometimes patients are not sufficient to take care of and if the patient is minor, then the consent from guardian is very much vital for the nurses in proceeding towards the care practice. In addition, nurses can never hurt the belief of any individual and they should consider their feelings and emotions while taking care of the patients (Omer, Suliman & Moola, 2016). While dealing with infectious diseases, the ethics should also be considered so that it cannot hurt the patient’s mind (Holm & Severinsson, 2014). So, ethics is considered as one of the integral parts of nursing and all the nurses should maintain it in order to give value to their work and profession by respecting the thoughts and opinions of the patients as well as their family members. Being a registered nurse, Jade is also bound to follow all the codes of ethical as well as behavioural conducts. Even, she also wanted to be honest to the patient’s family and therefore did not hide anything from the Bethany’s mother.
Professional Nursing Standard
Nurses need to follow various rules and regulations as per the National Standard policy for the nurses (Prinsloo & Slade, 2015). They always work hard in order to elevate the nursing profession by following the rules and norms of ethical standards set for them. RN practice requires continuous thinking and analysis before taking any serious decision regarding the patients’ health. The practice of nurses includes comprehensive assessment and development plan for evaluating any outcome (Clarke & Knights, 2015). The registered nurses of any healthcare organization need to follow various standards that include building trust, providing safety, comprehensive assessment, developmental plan and critical thinking while handling patients under them. Beyond the physical support, nurses are bound to provide emotional support to the patients and their families (Tompkins, Hobelmann & Compton, 2017).
Medico-legal issues, decision making and interdisciplinary teamwork in this case
While coming to the hospital, Jade overheard the conversation of the nurses in the elevator who were talking about Bethany and they were also stating their views against the decision of Bethany’s mother. Doctors need to take many decisions going against the ethics for the goodwill of patients. But, in this case, they could not forcefully feed the medicines as her mother was standing as a barrier. So, they were seeking for a legal order which will assist to cure this patient by providing right to give medicine to the patient. This would also not allow Bethany’s mother and other relatives to visit her during the treatment procedure. But, there is a fine difference between the medical ethics and nursing ethics and due to that, Jade found it ethical to disclose the fact to the patient’s mother (Broadbent, Groves, Shields & Power, 2015).
Here in this case, Bethany was not an adult and so there was a need to involve her mother while taking any decision regarding her health. Jade was a newly registered nurse and during her education she learned that building trust with the patients and their families is the primary and most important requirement of any nursing practice. All the nurses are bound to be ethical while taking decision. Jade was working as registered nurse but she was not working individually to treat the patient. Many other nurses of other shifts, doctors and coordinators all were involved in the treatment procedure of Bethany. So, it was clear that she was working in a team and being a team member she does not have the right to take any decision independently which she did disclosing the plan of team to the mother of the patient. It was against the rule of interdisciplinary teamwork. Lisa, the coordinator was angry on Jade because of her deed. Nurses are concerned with health as well as safety of the patients. While maintaining the ethics in the workplace, the role of nurses is to provide health assistance to the patient (Regan, Laschinger & Wong, 2016).
The paper discussed how a decision to handle dilemma was not fruitful and resulted in serious problem for the decision maker. Although, maintaining ethics and clinical responsibility was given priority by the nurse but it was failed to provide satisfactory result for the wellbeing of the patient’s health (Meyers, 2016). Again, she was not well coordinated with her fellow nurses as she arrived late on that day to the hospital and she could not properly listen what were told by the nurses of other shifts regarding the health issues of the patients (Bray et al., 2014). However, ethics are most important in nursing practices (Woods, Rodgers, Towers & La Grow, 2015). Building trust and staying clear to the patient and their families should be the highest priority for any nurse while working or providing care but, in this case decisions were needed going beyond the ethical standards just for the benefit of the patients health (Coyte & McKeever, 2016).
The above dilemmatic situation was quite difficult to handle for a freshly registered graduated nurse. Jade was not experienced in taking care of such situations. During her education her learning about maintaining the ethical standard was first priority for her. But the following recommendations could help her in dealing with such kind of dilemmatic situation that would help to maintain the work life balance and support the healthcare progress too.
- If Jade would discuss the whole matter of dilemma to her coordinator before taking any decision and if she would have looked for doctor’s opinion, then it could help her before taking and decision regarding the patient’s health.
- Again, sometimes, going beyond the ethical barrier to gain the health benefit of the patient is not considered as a bad practice in healthcare (Meyers, 2016). If Jade would have obeyed the suggestions of the doctors and provided medicines to the patient without informing her mother that could be helpful in treating her disease and the patient would not have left from the hospital without taking treatment.
Bray, B. D., Ayis, S., Campbell, J., Cloud, G. C., James, M., Hoffman, A., ... & Rudd, A. G. (2014). Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. PLoS medicine, 11(8), e1001705.
Broadbent, L., Groves, H., Shields, M. D., & Power, U. F. (2015). Respiratory syncytial virus, an ongoing medical dilemma: an expert commentary on respiratory syncytial virus prophylactic and therapeutic pharmaceuticals currently in clinical trials. Influenza and other respiratory viruses, 9(4), 169-178.
Clarke, C. A., & Knights, D. (2015). Careering through academia: Securing identities or engaging ethical subjectivities?. Human Relations, 68(12), 1865-1888.
Coyte, P. C., & McKeever, P. (2016). Home care in Canada: Passing the buck. Canadian Journal of Nursing Research Archive, 33(2).
De Vries, K., & Plaskota, M. (2017). Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer. Palliative & supportive care, 15(2), 148-157.
Dwarswaard, J., & van de Bovenkamp, H. (2015). Self-management support: a qualitative study of ethical dilemmas experienced by nurses. Patient education and counseling, 98(9), 1131-1136.
Ganz, F. D., Wagner, N., & Toren, O. (2015). Nurse middle manager ethical dilemmas and moral distress. Nursing ethics, 22(1), 43-51.
Holm, A. L., & Severinsson, E. (2014). Reflections on the ethical dilemmas involved in promoting self-management. Nursing Ethics, 21(4), 402-413.
Meyers, T. W. (2016). The Relationship between Socioeconomic Status (SES) and the National Council Licensure Examination for Registered Nurses: Comparing SES indicators in Mediated and Moderated Logistic Regression (Doctoral dissertation, Kent State University).
Omer, T. A., Suliman, W. A., & Moola, S. (2016). Roles and responsibilities of nurse preceptors: Perception of preceptors and preceptees. Nurse education in practice, 16(1), 54-59.
Prinsloo, P., & Slade, S. (2015, March). Student privacy self-management: implications for learning analytics. In Proceedings of the fifth international conference on learning analytics and knowledge (pp. 83-92). ACM.
Regan, S., Laschinger, H. K., & Wong, C. A. (2016). The influence of empowerment, authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration. Journal of nursing management, 24(1), E54-E61.
Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: the QSEN competencies redefine nurses’ roles in practice. Nephrology Nursing Journal, 41(1), 15-22.
Smebye, K. L., Kirkevold, M., & Engedal, K. (2015). Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC health services research, 16(1), 21.
Tompkins, D. A., Hobelmann, J. G., & Compton, P. (2017). Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug and alcohol dependence, 173, S11-S21.
Woods, M., Rodgers, V., Towers, A., & La Grow, S. (2015). Researching moral distress among New Zealand nurses: a national survey. Nursing Ethics, 22(1), 117-130