Ethical Decision Making, Research Paper Example

Summary

The nursing process requires that a nurse communicate with the patient from diagnosis through planning of the care to be given, up until the treatment is evaluated for effects. Unless the patient is indisposed and thus needs a proxy, the primary duty of a nurse is to the patient and not to relatives, friends or family members. Indeed, the nurse must always bear the good of a patient at heart, when providing care, irrespective of the circumstances. This constitutes a central guideline in the nursing process decision making.

The Nursing Process

The term nursing process refers the procedure used in the daily administration of patients by nurses with the aim of improving their health while also assisting the doctors to treat the same patients. Nursing procedure of operation constitutes practices and theories taught in nursing schools globally (Husted, 2008). The process involves five core phases of care namely, assessment of  a patient’s health needs, diagnosis of the patient’s needs the nurses must address, consultative planning of the care to be given to the patient, the implementation of the planned care and finally the evaluation of effectiveness of the implemented care.

One thing to note is that the nursing process is based on a problem solving methodology, since the work of a nurse is almost always a problem (Smith, 1996). This is more so when it comes to ethical decision making. A typical case would be a woman patient diagnosed and being treated for terminal cancer and who insists to know the prognosis of her condition. A typical complication to such an incidence would be the woman’s husband demanding that the nurses caring for his wife should never discuss the disease with her.

In such incidences, it is worth noting that a nurse’s primal concern is health improvement and care of the patient, which in itself demands physical health and emotional aspects relevant to the patient’s health. While a nurse may worry, understand the husband’s rationale and even feel sorry for him, her primary concern is the emotional torture of keeping the inquisitive patient in the dark. At all times, nursing care involves close communication between the patient and the nurse, which is vital for the implementation of care and treatment.

Ethical Decision Making Basis

If third parties, whether spouses, relatives or family members impose their directives on a nurse, there are two professional practice policies that a nurse can use to make decisions on the right process of care (Smith, 1996). The conventional practice requires that a patient’s care be entrusted to him or her for as long as they have the ability to make decisions. In this respect, if a patient is not in a position to make a logical decision, the health care proxy policy is used to determine the type of care adopted.

A health care proxy policy is a written requirement and or directive designating another person other than the indisposed patient, to assume the role of making health care decisions for and on behalf of that patient (Everett, 1991). So if a patient under the care of a nurse is unable to make logical and sound decisions of the care being given or needed, then the nursing process allows a designated person in the name of a proxy or agent to make such decisions.

Another important guide in the nursing process decision making is the Patient Advance Directive. For instance, if a patient’s level of sedation required appears to dull the patient and put him or her in a near-coma state, the patient’s relatives and family may request that the nurses administer a reduced dosage of pain medication (Daly, 2005). This usually happens when the family members fear that higher sedation would hasten death. In professional practice, a nurse can impose Patient’s Advance Directive, which states that pain medication must always be administered when needed to alleviate suffering, which is only a doctor’s and nurse’s prerogative (Daly, 2005).

Application

In our first illustration, it was evident that the nurse had a dilemma. She had to make a decision on the care to give the terminal cancer patient. Consequent to our analysis above, it is certain that the right thing to do would be to discuss with the woman about her condition since diagnosis has already been done. Next the nurse should help the woman patient to plan on the right treatment and care, to help her understand how the care plan would be implemented and what to expect and finally. The final step would be to help evaluate the care progress with time. As already noted, communication between a nurse is very vital in care giving.

The second point here is that the husband cannot act as a proxy since the woman is still able to make decisions about her condition. The first duty of the nurse is to the patient and not to the husband. Protecting the patient from bad news of a condition is a disservice to that patient, especially if you are providing care with intent to better her state (Daly, 2005). Finally, the psychological trauma of denying the inquisitive woman a sensible answer could be worse than telling her the trust in an informative way.

References

Daly, J. (2005). Professional Nursing: Concepts, Issues, and Challenges. New York: Springer Publishing Company.

Everett, K. (1991). The Memoirs of America’s Family Doctor. London: Random House.

Husted, J. et al. (2008). Ethical Decision Making In Nursing and Health Care: The Symphonological Approach. New York: Springer Publishing Company.

Smith, K. (1996). Ethical Decision Making in Nursing: Implications for Continuing Education. Journal of Continuing Education in Nursing, 27 (1), 42-4.