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There are some behaviors that indicate potential boundary crossing by nurses when dealing with patients. The first red flag is spending more time than is required with a patient. This shows that the relationship between the two has moved from professional to personal businesses that may negatively affect output (Erikson & Davies, 2017). Secondly, showing favoritism to a particular patient is another alert sign of professional boundary crossing.
Another common alert sign of professional boundary crossing is discussing intimate issues with patients. While a nurse may need some personal information about a patient while taking care of them, such data as likes and dislikes and other intimate details is often a sign of professional boundary crossing (Erikson & Davies, 2017). Also, engaging in behavior that could be reasonably interpreted as flirting constitutes an alert sign.
Meeting patients in settings other than those for provision of care is also a warning sign of professional boundary violation (Erikson & Davies, 2017). This include meeting patients at home or for coffee after they have been treated. Also, if patients start asking questions about a particular nurse, professional boundaries may be crossed.
Terminal sedation is an end-of life intervention to end suffering as the last result. To relieve suffering that has not responded to other means, the patient is sedated to the point where refractory symptoms are controlled. With no intention of causing death, the patient is sedated to an unconscious level (Bryer et al., 2019). These drugs may result in his/her slow and painless death.
Rational suicide involve a well-thought out decision by an individual to die. Rational suicide occurs when a person reasons and decides to end their own life. In this case, the patient in end of life care should also be capable of action so that they can administer the drug (Bryer et al., 2019). Therefore, they administer the lethal drug on themselves rather than by a medical professional or other persons.
Assisted dying involve the hastening of death by administration of a lethal substance. In assisted dying, a drug or lethal substance is administered to the patient to end their life (Bryer et al., 2019). In this case, there can be active euthanasia where someone other than the patient carry out the action that ends the life.
One major moral dilemma with end of life care is regarding hastening death or the principle of double effect. Some decisions that a nurse will make produce both negative and positive effects. For example, while a nurse may need to administer pain medicine, the drug may have negative effect on the patient (Masters, 2017). Here while the principle of non-maleficence apply, the nurse is in a dilemma or whether or not to administer.
Another moral dilemma in end-of life care is that involving respect for autonomy. According to Harwood (2020), patients have the right to make decision in regard to their treatment preferences. However, there are limitations when it comes to observing certain patient requirement which may have negative effects. Nurses often find themselves digressing from the patient’s preferences in treatment.
Another major challenge with end of life care is in regard to disclosing prognosis or diagnosis to patients. Due to religious beliefs, emotional reactions and other factors, family members may request nurses not to disclose results of diagnosis to patient (Harwood, 2020). As this act against nursing ethics, it present an ethical dilemma due to potential consequences of the disclosure.
Bryer, E., Neault, M., & Mintzer, D. (2019). Managing Dying: Medical Care and Decision Making at the Very End-of-Life. Palliat Med Care, 6(1), 1-6.
Erikson, A., & Davies, B. (2017). Maintaining integrity: How nurses navigate boundaries in pediatric palliative care. Journal of pediatric nursing, 35, 42-49.
Harwood, R. H. (2020). Ethical and moral dilemmas including do not attempt resuscitation orders, advanced care planning, and end-of-life care. Stroke in the Older Person, 283.
Masters, K. (2017). Patient-centered care and professional nursing practice. Role development in professional nursing practice, 273-278.
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