Unilateral Decision-Making by Nurses, Essay Example

The nurses should not go against Jennie’s, wishes by inserting a tube to feed her. The patient, Jennie made a directive against providing food to her through a feeding tube prior to her present condition. She was competent enough while making the directive. The advance directive meant that even when she became incompetent the directive would be binding. Jennie had initialed that she did not want any surgery, heart-lung resuscitation, dialysis, antibiotics, mechanical ventilator or tube feeding.” It should have been the concern of the medical director to read Jennie’s advance directive before consulting the family. The nurses’ director’s main concern was on the length of time the patient spent with the CAN, and not what was best for the patient. Frequent meals that the patient can tolerate, and that would not take long feeding are of significant benefit. Drinking lots of fluid need to be emphasized for Jennie. It is not in order for the patient to be fed for over two hours because the food can get cold, and the patient can be bored eating the same food for all that time. Feeding the patient for a long time with the same food is not advisable because this may encourage the growth of microorganisms, and the food can lose taste and become unpleasant for the patient.

Unilateral decision-making by nurses, physicians or any other persons should be discouraged in health care. It is true that nurses play a critical role in making decisions that concern health care. Although nurses usually make ethical decisions independently, there are numerous ethical issues, which require interdependence of nurses in decision making. The issue of Jennie consists of an ethical decision that should not have attracted an independent decision as done by the director of nurses. The director of nurses should have sought the views from the other members in the ethics consultation team. The members include the physician, chaplain, administrative personnel, social worker and the legal representative of patients. Nurses should be advocates of patients and independence is the most crucial characteristic, which deserves honour. Jennie has made a wish that she should not receive food through a tube, and, therefore, the nurses’ director should advance her wish. The director should refer Jennie to a speech therapist before making any decision. The speech therapist would help in evaluating the diet for the patient and offer a pure diet that is both easy to swallow and palatable. The engaging of a speech therapist will also ensure that the patient does not face risks of aspiration. The nursing staff needs to encourage Jennie to take fluids in plenty by giving her small amounts often because the patient is at a risk of dehydration. There is less activity at the nursing home, and the patient’s metabolism has become low. Therefore, less nutrition is advisable. Forcing the patient to take a lot of food will impair her metabolic activities or even worsen her other ailing conditions.

It is in order that the administrator consults the director of nurses to peruse through the patient’s directive. Afterwards, the director should have a discussion with the ethics committee to reiterate the rights of the patient and honour her wishes in the directive. If it the patient’s condition worsens to the point of not eating and swallowing, the patient can be referred to hospice, by an interdisciplinary team, to receive advanced care and comfort.