Last Updated on 08/24/2023 by Admin
Apply Guidos MORAL model to resolve the dilemma presented
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Assignment:
Complete both case studies:
- Apply Guidos MORAL model to resolve the dilemma presented in the case study described in EXERCISE 4–3 (Guido textbook). How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among thenursingstaff, and what are the positive actions that the nurses might begin to take to prevent moral distress?
2. Read the case study entitled You be the Ethicist, presented at the end of Chapter 3 (Guido textbook). What are the compelling rights that this case addresses? Whose rights should take precedence? Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? How would you have decided the outcome if his disease state had not intervened? Now, examine the scenario from the perspective of health care policy.
How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy? Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
REQUIRED SOURCES:
- Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ:
Prentice Hall. (Chapter 3 and 4) - Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Boston: Jones and
Bartlett. (Chapter 1 and 4)
Expert Answer and Explanation
Ethical and Legal Issues in Nursing
Professionals in nursing get faced with several ethical and legal issues in the course of carrying out their practice. Nurses experience different kinds of stress in their practice environment when dealing with different medical circumstances. Moral distress is a situation that occurs when a nurse gets confronted with two conflicting principles of ethics. For example, deciding between acting upon the patient’s wishes and what the nurse knows to be the best thing to do for the patient. This paper aims to discuss the ethical dilemmas with regard to moral distress and determination of rights.
Case Study; Exercise 4-3
Nurses’ Response to the Physician’s Request
In responding to the request of the physicians to the nurses for them to talk to the family of the patient about the transfer of the patient to another facility. The nurses are bound to experience uncertainty in their morals in which they are unsure about what the right course of action is based on the sentiments of the family and the patient’s medical history. The patient’s condition seems hopeless to the extent that she no longer recognizes family who as such, intended to stop visiting her. However, the nurses can follow the instructions of the physician, but the final decision gets made by the family since the patient lacks capacity.
Link to Moral Distress among the Nursing Staff
The nursing staff in the scenario would begin experiencing initial moral distress based on the fact that the physician and the family of the patient have different opinions of what should be done and the burden lies on the nurses to decide whose instructions to follow. The family of the patient have voiced their concerns on what the patient would have wanted with regard to the use of the ventilator support, which, according to them, the patient would never have accepted.
Trying to convince the family to transfer the patient for advanced treatment with instructions from her primary physician would cause significant distress to the nursing staff because they would be caught between what the patient’s family want and what the physician thinks is right for the patient (Campbell et al., 2018). The physician has his reasons just like the patient’s family do, and as such, trying to convince the family otherwise would be a stressful task for the nurses.
Positive Actions that the Nurses Might Begin to Take to Prevent Moral Distress
Medical studies present several actions that the nurses in this kind of stressful scenarios can begin taking in a bid to manage moral distress. They may start by voicing their ethical concerns, which is something that should be allowed in their practice environment as this will allow them to cope better with such situations in future thus minimize the possibility of them experiencing moral distress (Guido, 2014). Raising their ethical concerns will help them to cope better with situations when they experience moral distress.
The orientation programs for new nursing employees should include use of experts in ethics to provide them with information concerning moral distress to be discussed in settings that are neutral to educate them on identifying, understanding as well as making use of the available resources in the organization to prevent moral distress.
Some of these resources may include making use of the services for counselling to help them understand what moral distress entails and how to manage it in the course of their practice (Lachman, 2016). The nurses can also begin by asking the healthcare organization to provide intervention programs for nurses to help them reduce moral distress.
Case Study, You Be the Ethicist; Chapter 3
Compelling Rights Addressed by this Case
This case addresses some rights that are compelling, with the most significant being the right to refuse treatment. After the nurses and physicians have exercised veracity by telling the patient the whole truth about his condition, then providing options for treatment and the expected outcomes, the patient is allowed to exercise his right to accept or refuse treatment.
However, in cases where the patient is a minor like in this case of the 14-year-old boy, the parents or guardians are granted that right to make the decision for him because of the minor lacks capacity to make sound decisions (Pozgar, 2013). The legal doctrine of informed consent reflects on the concept of autonomy whereby the healthcare providers inform the patient of their condition and the options of treatment while the patient or guardian makes the final decision.
Whose rights should take precedence?
The rights that should be prioritized in this case are the patient’s because the element of concern is the welfare of the patient, and as such, his needs should come first—for instance, the right to receive treatment which requires healthcare providers to provide quality care. The patient’s right should be prioritized because every decision made revolves around his health condition and the decisions that get made directly affect him.
Whether a Child Should Have the Right to Determine His Outcome
The general rule, especially with regard to life-changing decisions in healthcare is that a minor does not have the capacity to make sound decisions about their health. As such, the decisions are left to the guardians and parents to make choices for the child’s best interest as they are made on behalf of the minor. However, there have been some exceptions where the minor is competent enough to be part of the decision making.
In this case, where the condition in question is a chronic disease, I think the patient should ethically have the right to decide what happens to him, with informed consent applied (Ruhe et al., 2016). This is because he is the one directly affected by the medical condition and will be the one to live with the consequences of his decision. In this case, the amputation of the leg, which is a critical step that needs not be imposed.
How I Would Have Decided the Outcome
My decision on the case’s outcome would have been to uphold the decision made by Tyrell and his parents based on his right to refuse treatment. The parents, who were adults of sound mind were responsible for making the decision on behalf of the patient, and if they agree with the patient and think it is better if he does not proceed with the suggested treatment, then their decision is final. The healthcare team has no choice but to accept the decision because their role is only to provide options and advice, but not to make the decision for the patient.
Evaluation of the Need for the Policy
I will begin the evaluation of the need for the policy by communicating the details of the policy to the individuals in the organization who will be affected by it. In doing this, I will explain what the policy is, why I intend to have the policy implemented, how it will affect the individuals in terms of the positive and negative effects as well as explain the role the policy will play in improving the quality of care in the organization. I will ensure that I communicate the importance of this policy and how I intend to handle the negative consequences that may come with its implementation.
Because a new policy comes with some significant changes, it is important that I communicate it to the members of the organization sooner than it gets implemented so that I can give them time to adjust to the idea of change. Early communication also gives the organization enough time to conducting training of the employees on how to handle new procedures that may come with the policies. This will give the employees enough time to assess the policy and give them a reason to support the policy because they would have understood it and its value to the organization.
Process Proposal for The Organization
Guidelines
The effects of failure to accept treatment by a patient or failure of the guardians of a patient to allow treatment can have adverse effects on the health of a patient by possibly making the situations worse. In the case scenario, for instance, the parents of the minor refused to allow treatment and as such, a lot of time was wasted arguing about it in court eventually leading to the patient’s condition becoming worse because treatment had been stopped.
The best way to deal with such situations will be to establish a policy that will allow primary physicians to be allowed to continue with the treatment and keep the patient healthy until a decision is reached in court as to whether or not to continue the treatment.
Procedures
The methods that I will use in creating the process proposal for the organization would be to first form a team of individuals who will help in the evaluation process. I will then collect data that is accurate with regard to the effect the policy may have on the well-being of the members of the organization who will be affected by it. I will then analyze the data that will be collected to establish whether the changes will be effective and lastly share the results of my findings on how the proposed policy will impact the organization with everyone who would be affected by it.
Policies
In relation to the case in the scenario above, primary physicians should be allowed to make treatment decisions for patients who are suffering from chronic diseases in instances where the physician has, based on evidence, a reason to believe that the particular treatment will improve the lives of the patient for the better. For instance, in a situation where the condition of the patient is critical, and the particular procedure or treatment can save their life. In the case scenario above, the life of the patient would have been saved if the healthcare providers had been allowed to carry out the procedure, they believed would save his life.
Conclusion
The first case study addresses the issue of moral distress which is a problem that most nursing professionals experience in their professional practice. Policies that require education of nurses on moral distress at the time of orientation at the beginning of their practice can be a significant step in reducing the effects of moral distress.
The second scenario is more about informed consent which is meant to protect the patient from malpractice issues as he has a right to refuse treatment. However, sometimes that right can lead a person to become worse and even lead to death. Therefore, organizations need to establish policies that ensure the quality of care and allow physicians to make decisions that are in the best interest of patients.
References
Campbell, S. M., Ulrich, C. M., & Grady, C. (2018). A broader understanding of moral distress. (pp. 59-77). Springer, Cham. Retrieved from https://link.springer.com/chapter/10.1007/978-3-319-64626-8_4
Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Prentice-Hall. (Chapter 3 and 4)
Lachman, V. D. (2016). Moral resilience: managing and preventing moral distress and moral residue. Medsurg Nursing, 25(2), 121.
Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Boston: Jones and Bartlett. (Chapter 1 and 4)
Ruhe, K. M., De Clercq, E., Wangmo, T., & Elger, B. S. (2016). Relational capacity: broadening the notion of decision-making capacity in paediatric healthcare. Journal of bioethical inquiry, 13(4), 515-524. Retrieved from https://link.springer.com/article/10.1007/s11673-016-9735-z
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