The America Nurses Association (ANA) is clear about the ethics and values of registered nurses who choose to practice. It has many provisions explaining the basic commitments and values of nurses. These values guide the nurses in exploring the different ethical scenarios that might arise in the course of providing health care. The case of Mrs. R. provides an ethical dilemma to the nurses. The physician has instructed the nurses to talk to the family of the patient to ensure that Mrs. R. get a transfer to the major medical center for advanced care. The advanced care includes active physical therapy and rehabilitation. Considering that the patient’s family has raised concerns over the use of the ventilator, it is considerable that they will be reluctant to accept transferring the patient to an advanced center. In addition, the physician is reluctant to change his mind about the prescription. However, the nurses have to act on the request of the physician.

According to ANA, the primary commitment of the nurse is to the patient (American Nurses Association, 2010). In this situation, the patient has lost the ability to recognize the family members in which case the family members becomes her decision makers. The decision of the family members is considerably the decision of the patient. The family members argue that the patient would never have wanted such care. The nurses have a professional commitment to the patient but also have to follow the orders of the physician. This situation poses an ethical dilemma. If the nurses follow the orders of the physician, then they have broken their commitment to the patient. However, failure to follow the orders is also not ethical. In this case, the nurses have to make a decision. The nurses might reevaluate their ethical values and advice the family members to transfer the patient (Guido, 2014). The nurses might also ignore the orders and advice the family members not to transfer the patient.  The nurses might also follow their ethical values and make a decision based on them and not a decision based on the orders of the physician.

Moral Distress

When one feels powerless to take the ethically correct action, then moral distress kicks in. In the case of Mrs. R., the family members who have the authority to make medical decisions for the patient want the ventilation stopped. However, the patient’s primary physician who has worked in the community for many years is very reluctant to comply. Two mutually exclusive actions, which are justifiable ethically, are possible in this case. Moral distress, in this case, will occur when the nurses identify the moral action to take but have no power to take it. If the nurses identify that the ethical decision is to follow the wishes of the family members, then they will have no power since the ultimate decision lies with the physician. Again, if they decided that the ethical action is to transfer the patient to advanced care, then the family members who have the responsibility to transfer the patients will not comply.

In both of the situations presented, the nurses have no power to take any of the actions. Thus moral distress will occur. The physician and the family members have the ultimate power to make each of the ethically justifiable actions but the nurses have no power.  However, the nurses can take some actions to prevent moral distress. One of the actions is to become aware of the distress, self-reflect and make a commitment to take care of oneself (Guido, 2014). Moral distress can lead to anger, Guilt, resentment and can make one lose faith in a profession. Thus, it is significant to become aware of the distress and make a commitment to work on it. Another action the nurses can take is to raise their concerns with higher authorities. They are in an ethical dilemma, and it would only be advisable to consult a higher authority (Epstein & Delgado, 2010). In so doing the nurses will have the feeling of doing the right thing and prevent moral distress. However, before taking any action, the nurses should evaluate their ability to act since acting can increase the moral distress especially when the outcome of the act is negative.

Exercise 4.1

The nurse should be committed to the patient. Besides, the laws provide that nurses should comply with discharge orders, treatment plans, and prescriptions. Failure to offer effective advice to the patient is not ethical. Professionally, the nurses should act ethically and morally. Nurses have a moral right to ensure that their patients are on the right track of treatment. The order to limit the discharge instructions to essential facts contravenes professional ethics. The options available are to continue taking enough time with a patient and avoid moral stress. The other option is to follow the head nurse orders and act unprofessionally.

The option, which respects the right of all stakeholders, is to provide optimal health care to the patients. The ANA stipulates that nurses have the authority and are accountable and responsible for the health care quality they provide (American Nurses Association, 2010). The lack of competent advice to the patients contravenes this policy. If anything happens to the patient due to lack of optimal advice, the patient’s nurse is accountable and not the head nurse. Using the moral model, the nurses should continue providing optimal health care to their patients and write a letter to the head nurse explaining their decision. This ensures that the rights of the patients are respected, and the head nurse receives due respect as an authority body. After some time, the nurse’s should look back and evaluate the consequences of the decision. If the overall quality of health care in the facility is decreasing, they should reevaluate their decision.

Case Study Presented At the End of Chapter 3

What compelling right does this case address?

The compelling right presented in this case is autonomy, which is the right to decide what will happen to one’s person. The right of the patient is respected even when the heath care providers do not agree with the decision of the patient. Autonomy has four components including independence, liberty self-determination and agency (Guido, 2014). Liberty is the right to choose without any coercion, self-determination is the ability to access the need information to make a choice, independence is being able to reason and act for oneself and agency is the power to be responsible for one’s decisions.

Whose rights should take precedence?

The rights of the patients should take precedence. The patient has the autonomy to decide what should happen to him/her. In addition, the patient has the liberty to make a choice without coercion. The health care providers should always respect the right of the patient unless the patient’s right is endangering others in which case the right of others takes precedence.

Does a child (here, a competent 14-year old) have the right to determine what will happen to him? Should he ethically have this right?

The child is competent meaning that he can make reasonable decisions. In addition, the capacity to consent is not age dependent rather it has a basis on competency for both adults and minors. This hands the child the right to determine what will happen to him. He is capable of making reasonable decisions regarding his health. The health care team ought to respect the right of the boy who as a Christian chooses to leave his health in God’s hands. Ethically, the boy has the autonomy to choose what will happen to him (Guido, 2014). The health care team has laid out the facts about his condition, and he has the liberty to make a free decision. In addition, he is ready to take responsibility for the decision.  Thus, the boy ethically has the right to choose what will happen to him.

How would you have decided the outcome if his disease state had not intervened?

The boy had previously consented to receive chemotherapy, which was agreeable to all the parties. However, when he made a decision to withdraw, the health care team disagreed with the patient. The patient is competent and can make reasonable decisions. In addition, his parents are in support of his decision meaning there is no disagreement between the patient and the family members. The disagreement lies between a competent patient and the health care team. According to the state’s laws, the physicians must respect the autonomy of the patient no matter the outcome. The patient had the facts laid out, and he made a decision ready to handle the consequences of the decision. Had the disease state not intervened, I would have ruled for the patient.

Evaluating the need for the policy

The health care policy gives the first commitment to the patient. This means that the health care providers must act in respect to what the patient wants. However, it is arguable that the health care providers have a better understanding of the consequences of the decisions made by the patients. In evaluating the need for the policy, I would start by looking at why the policy was initiated in the first place. The policy protects the right of the patient. It prevents the health care providers from making decisions about the health of a patient. However, it is agreeable that in cases of some diseases, the autonomy should be age-limited., lack of treatment for diseases such as cancer leads to quick death. It is painful for a health care provider with the power to do something to be limited by the autonomy of the patient. Paternalism though considered an undesirable ethical principle is applicable in such cases. The questions outlined by Malone assist in the process of policy evaluation in that they act as a guide to identifying gaps in the policy. A proposed policy to address the issue would state that a patient has the autonomy to make the ultimate decision except when the patient is a minor and has a chronic disease.

References

American Nurses Association. (2010). Nursing: Scope and standards of practice. Nursesbooks. org.

Epstein, E. G., & Delgado, S. (2010). Understanding and addressing moral distress. Online Journal of Issues in Nursing, 15(3).

Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall.

 
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