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A. The question of whether abortion is is ethical or not primarily pertains to how a person views abortion according to their own believes. Abortion clinics are not illegal as long as they comply with standards set forth by the state such as providing the necessary area and equipment for interventions, to have these performed by a licensed physician and to be able to transfer a patient to a hospital facility should they need emergency services following an abortion or complications (The Florida Statutes, 2019).
b. Patients must be allowed to exercise autonomy whenever possible. This is legal and ethical. Many patients have advance directives stating what interventions they want for their health. It is the nurse’s duty to respect these wishes regardless of their own views. This is ethical because you are respecting the patient’s autonomy and legal because there may be a document that states such decisions (Weiss, Tappen & Grimley, 2019).
c. A health surrogate is legally appointed to make decisions for the patient. However, the issue of ethics may arise when some people think it’s too soon to remove life support or when the possibility of recovery has not been ruled out. As nurses we provide care to maintain a patient’s optimal level of functioning and to allow for dignified death when there is no other option. The concept of end of life however poses many ethical dilemmas in some nurses as they become more knowledgeable in this area (Weiss et al., 2019).
d. Diverting drugs is both unethical and illegal. The nurse that participates in this is incurring in medication error by administering less than the prescribed dose and stealing. These are both reportable issues because they put both the nurse and the patient’s life at risk. Impaired coworkers need to be reported and explore the possibility of rehabilitation (Weiss et al., 2019).
Deontological theory is based on the idea that a person is performing an action based on good intentions and what they believe is ethical based on their rules. However, the breaking of these rules even if with justifiable motives is considered wrong (Weiss et al., 2019). Utilitarianism argues that the most correct approach is the one that will generate the best outcome for the most amount of people. It takes into account the interests of others and not solely that of one person (Driver, 2014). Principlism is a relatively newer approach that combines other principles in order to address dilemmas while making emphasis on autonomy, non-maleficence, beneficence and justice (Weiss et al., 2019).
It is the responsibility of all healthcare professionals involved in patient’s care to provide accurate and reliable information regarding prognosis, treatments and medications. Some of this information may be distressful for some to hear however, knowing the truth can assists in properly managing conditions and preventing complications and ultimately it allows the person to make decisions on their own care. Not being honest violates the principle of veracity (Weiss et al., 2019). If you anticipate that the information that will be provided may cause distress it may be wise to ask for assistance from other members of the interdisciplinary group such as social workers, doctors or chaplains, also when starting this conversation make sure there are no interruptions and allow ample time for patient to ask questions and discuss concerns.
The nurse-patient relationship has its foundation in trust. Patients rely on nurses and other healthcare professionals for information and guidance regarding their health. Withholding health information can create ethical dilemmas between nurses and family members and violates the principle of veracity as well as the nature of the relationship (Weiss et al., 2019). If the family wishes to not disclose information to the patient the nurse can assist by discussing with the family their concerns and fears regarding the information and explore alternatives that ease the family’s concerns and allows the patient to be in control of their health and decisions (Weiss et al., 2019).
The code of ethics is one of the most fundamental aspects of any job. It provides a description of what is expected of a professional while at the workplace and provides a framework for nursing to function accordingly (Weiss et al., 2019). If a behavior is witnessed that does not align with the code of ethics it must be reported to the appropriate entity. Passwords must remain private as sharing them can lead to confidentiality breach and patient information is at risk. Every action carries a consequence therefore the person witnessing an unethical act can be held as responsible for the consequence as the person who initiated the act. Moral courage means bypassing the fear and holding true to your values and ideas of what is right and wrong (Schmidt, 2015).
Confronting colleagues can be difficult especially when friendships arise from the daily routine of working together. This can impair the judgement and affect the way a situation is viewed. Rather than assume she is taking the supplies I would talk to her regarding the child’s situation and how she is dealing with it and try to gain some insight as to not jump to conclusions. Offer support if necessary. Taking supplies is stealing and that is dishonest. The inappropriate handling of supplies can be costly to the unit. If I witness a nurse stealing and do nothing about it, I become an accomplice, and if I do say something and in fact, she needs those supplies for her daughter then I would be interfering with her daughter’s recovery. This type of dilemma is usually what causes moral distress in nurses, knowing what the right action is but not being able to take it (Weiss et al., 2019).
There are many aspects of end of life care that create dilemmas in nurses. A nurse needs to examine her own views and feelings before acting as to not project her own perspectives. A terminal disease as the word implies is one with no cure. However, two people may run different courses even with the same disease therefore estimating the time someone has left is difficult and often creates more anxiety in the patient. As a nurse I would explain to the patient that while it is unfortunate that his disease has no cure, he should take comfort in knowing we can work toward making the rest of his time valuable, meaningful and with dignity. We can use the time to reflect on his life, his achievements, happy moments and even not so happy ones. I would take time to discuss fears such as painful death, dying alone and feeling isolated. Patients wit terminal disease fear this more than the actual death itself and by exploring those feelings we can help them process the situation more effectively and find coping mechanisms (Trivate et al., 2019). Grieving is a normal part of the process and not being honest for fear of mentioning the word death can affect this.
The patient has the right to know what he is taking. As a nurse I would explain what it is for, what to expect and possible side effects. The nurse has the duty to provide this information and accept that the patient has the right to refuse this medication as well.
Driver, J. (2014, September 22). The History of Utilitarianism. Retrieved May 17, 2020, from https://plato.stanford.edu/entries/utilitarianism-history/
Schmidt, K. (2015, October 19). Nurses must summon moral courage to confront unethical behavior. Retrieved from https://www.nurse.com/blog/2015/10/19/nurses-must-summon-moral-courage-to-confront-unethical-behavior/
The 2019 Florida Statutes. (2020, May 17). Retrieved from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0300-0399/0390/Sections/0390.012.html
Trivate, T., Dennis, A.A., Sholl, S. et al. Learning and coping through reflection: exploring patient death experiences of medical students. BMC Med Educ 19, 451 (2019). https://doi.org/10.1186/s12909-019-1871-9
Weiss, S. A., Tappen, R. M., & Grimley, K. A. (2019). Essentials of nursing leadership and management (7th ed.). Philadelphia, PA: F.A. Davis Company.
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