Apply Guido’s MORAL model to resolve the dilemma presented in the case study described in Ethical Scenario 4-3 on p. 48
For this week assignment, create a PowerPoint presentation based on the following case studies.
Read the case studies and answer the following questions:
Apply Guido’s MORAL model to resolve the dilemma presented in the case study described in Ethical Scenario 4-3 on p. 48 which is titled, “When Care Appears Medically Inappropriate,” (Guido textbook 7th edition).
- How might the nurses in this scenario respond to the physician’s request?
- How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?
Read the following case study and answer the following questions: “You be the Ethicist”, presented at the end of Chapter 3, p. 41, which starts, “Helga Wanglie…” (Guido textbook).
- What are the compelling rights that this case addresses? Whose rights should take precedence?
- Whose rights should take precedence?
- How might the institutions’ organizational ethics policies have impacted the outcome of this case?
- Leaving any legal issues aside, how would you have used ethical principles to decide the outcome of this case, if Helga Wanglie had continued to survive relying on life-sustaining measure?
Now, examine the same Helga Wanglie 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, p. 50) 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 TEXTS
- 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
Responses to Nursing Ethical Dilemmas in Guido’s Book
Making ethical decisions in healthcare settings is a process that nurses should understand in a move to perform their duties as required of them successfully. According to Pozgar (2013), nurses should avail of all the resources at their disposal to facilitate the ethical decision-making process. One of the support is the ethics committee. Healthcare institutions with an ethics committee should use the body to help nurses make informed decisions about healthcare ethics.
Guido (2014) argues that nurses should make ethical decisions making sufficient time so that an option that is supportable and workable can be reached. Guido (2014), in his book, asserts that the nursing environment has increasing barriers that have prevented nurses from ethically conducting their roles. According to Guido (2014), nurses can make ethical decisions in an environment that promotes creative thinking and educate them about the process. This paper uses Guido’s book to answer some critical ethical issues facing nursing during their practice.
EXERCISE 4–3
Nurses’ Response in this Scenario
Before the nurse responds to the physician in this scenario, the nurse must be aware of the hospital policies and protocols that guide the referral process. Also, the nurse should understand accepted standard procedures of care before making any response. The nurse should accept the physician’s orders because Dr. G.’s reasons are compelling enough and are focused in improving the wellbeing of the patient.
However, the nurse should not favor the physician’s assertions because he is his superior (Rainer et al., 2018). He should make a decision independently with the patient’s wellbeing in his mind. The services the doctor has mentioned to the nurse cannot be offered at the local hospital.
Thus, the patient should be treated at a medical facility that can help improve his health. Therefore, the nurse should ask the physician to give him time to talk to the family members. If they agree to change the hospital, the nurse should ask the doctor to write a referral letter so that the patient can be referred to.
Causes of Moral Distress in this Scenario and How to Handle them
Moral distress is a situation where nurses are unable to fulfill their duties due to institutional barriers (Aydin & Ersoy, 2017). This scenario can cause moral distress to nurses when the family members refuse to pay for the patient’s referral bills. The nurse might be willing to follow the physician’s advice and discuss with the family members about changing the hospital.
However, when the family members are not in agreement with the nurse, the nurse can be so stressed. Thus, in this scenario, the main factor for moral distress are the family members. The physician might also frustrate the nurse and force him or her to follow the commands. Nurses can educate themselves about moral distress in a move to learn how to handle it (). They can also handle the situation by voicing their concerns to relevant people in the setting.
You be the Ethicist Case Study Questions
Compelling Rights Addressed by the Case
The case addresses two fundamental rights. The first right is the patient’s autonomy. This right argues that patients should be allowed to decide the fate of their health (Krautscheid et al., 2017). The second right is nurses’ right to advocate for their patients.
The Rights that Should Be Prioritized
The right that should be prioritized in this case is autonomy. The patient has been given the power to make decisions concerning their health, and nurses are obligated to obey this right to the latter even if the patient’s health is so severe.
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?
In the American constitution, children below 14 years do not have the right to decide over their lives (Krautscheid et al., 2017). The child should not have the right either ethically or legally because he is not mature enough to make informed decisions.
How would you have decided the outcome if his disease state had not intervened?
I would have decided with the patient’s wellbeing on the mind. Thus, I would have gone for the next therapy, which is amputation of the led to avoid the spread of cancer to other parts of the body.
How would you begin to evaluate the need for the policy?
I would begin to evaluate the need for a policy by showing other affected people the weakness of the current regulation. I would educate my peers and management that the autonomy policy should be restructured. I would convince them that nurses should be allowed to make decisions when they identify that the patients are making wrong decisions. My peers would support me because they also find themselves in situations similar to this one.
The 10 Framework Questions
The ten framework questions in the book can help in the process. Through the questions, a nurse can identify the problem and determine the affected people. Also, through the questions, a nurse can know people who can make the policy (Guido, 2014). In other words, the questions are vital to policy development. The process proposal below can be used in addressing the identified issue in the case scenario.
A Process Proposal
Situation
Patient autonomy has prevented nurses from conducting their duties to their full potential. The child, in this case, could have been free from cancer if his patients agreed that amputation therapy is done. However, they refused, and now the child has cancer in the liver. The autonomy policy should be relooked so that nurses and other medical professionals should challenge patients where they feel patients are crossing the line. In other words, nurses should have a say in some healthcare situations concerning patients’ health.
Policy to Address the Issue
Another policy should be created to regulate patients who abuse the right to autonomy. A committee should be created to solve treatment issues between nurses, other healthcare professionals, and patients. The tribunal should consist of healthcare professionals who are tasked with examining the suitability of therapy and religious leaders who will provide religious perspectives to the treatment. This tribunal will regulate patients who abuse their rights.
Procedures and Guidelines to Implementation of the Policy
The policy will be implemented by first researching patients who lose their lives in the name of autonomy (Pozgar, 2013). The information will be used to persuade other healthcare professionals to join the fight. A bill will be written and presented to the legislature for discussions. If it passes, then nurses will save more lives.
Affected People
People affected by the policy are healthcare professionals and patients. Nurses will have the legal power to challenge patients in a tribunal when they feel that the patients are abusing their right to autonomy. Also, patients will give their reasons why they do not want specific treatments.
In conclusion, ethical dilemmas follow nurses in every role they play in healthcare facilities. They can be frustrated by their bosses, including physicians. Also, patients can disappoint nurses by invoking their right to autonomy. However, the nurses can solve the issues by developing policies that will make their work easier and addressing their concerns to relevant authorities.
References
Aydin Er, R., & Ersoy, N. (2017). Ethical Problems Experienced By Nurses Who Work in Psychiatry Clinics in Turkey. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 8(2). https://pdfs.semanticscholar.org/4ab0/4d9127e461e2ea867d89535161d9e8dcf19e.pdf
Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall. (Chapter 3 and 4)
Krautscheid, L. C., Luebbering, C. M., & Krautscheid, B. A. (2017). Conflict-handling styles demonstrated by nursing students in response to microethical dilemmas. Nursing Education Perspectives, 38(3), 143-145. doi: 10.1097/01.NEP.0000000000000132
Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Boston: Jones and Bartlett. (Chapter 1 and 4). Retrieved from https://books.google.co.ke/books?hl=en&lr=&id=j7J5DwAAQBAJ&oi=fnd&pg=PP1&dq=Pozgar,+G.+D.+(2013).+Legal+and+ethical+issues+for+health+professionals+(3rd+ed.).+Boston:+Jones+and+Bartlett.+(Chapter+1+and+4)&ots=vLrsRpmawC&sig=u8PqQ_IJRWNh0hlF75KDrtaa5uo&redir_esc=y#v=onepage&q&f=false
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of clinical nursing, 27(19-20), 3446-3461. https://doi.org/10.1111/jocn.14542
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