Page 63 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch04_039-056.qxd 11/6/09 5:55 PM Page 50
50 unit 1 | Professional Considerations CikguOnline
box 4-2 not allow surgical interventions as they fear that
the “life force”may escape. Many cultures forbid
Questions to Help Resolve Ethical
Dilemmas organ donation. Other cultures focus on the sanc-
tity of life, thereby requesting all methods for sus-
• What are the medical facts?
• What are the psychosocial facts? taining life be used regardless of the futility.
• What are the patient’s wishes? ■ What are the patient’s wishes? Remember the
• What values are in conflict? ethical principle of autonomy. With very few
exceptions, if the patient is competent, his or her
decisions take precedence. Too often, the fami-
opinion has not been solicited. This is generally
ly’s or physician’s worldview and belief system
unwarranted, unless the issue involves a violation of
overshadow those of the patient. Nurses can
the professional code of ethics.
assist by maintaining the focus on the patient.
Nurses are frequently in the position of hearing
If the patient is unable to communicate, try to
both sides of an ethical dilemma. Often, all that is
discover whether the individual has discussed the
wanted is an empathetic listener. At other times,
issue in the past. If the patient has completed
when guidance is requested, nurses can help people
a living will or designated a health-care
work through the decision-making process (remem-
surrogate, this will help determine the patient’s
ber the principle of autonomy).
wishes. By interviewing family members, the
Collecting data from all the decision makers
nurse can often learn about conversations in
helps identify the reasoning process being used by
which the patient has voiced his or her feelings
these individuals as they struggle with the issue.
about treatment decisions. Through guided
The following questions assist in the information-
interviewing, the nurse can encourage the family
gathering process:
to tell anecdotes that provide relevant insights
■ What are the medical facts? Find out how the into the patient’s values and beliefs.
physicians, physical and occupational therapists, ■ What values are in conflict? To assess values,
dietitians, and nurses view the patient’s condi- begin by listing each person involved in the
tion and treatment options. Speak with the situation. Then identify the values represented
patient, if possible, and determine his or her by each person. Ask such questions as, “What
understanding of the situation. do you feel is the most pressing issue here?” and
■ What are the psychosocial facts? In what “Tell me more about your feelings regarding this
emotional state is the patient right now? The situation.” In some cases, there may be little
patient’s family? What kind of relationship disagreement among the people involved, just a
exists between the patient and his or her family? different way of expressing beliefs. In others,
What are the patient’s living conditions? Who however, a serious value conflict may exist.
are the individuals who form the patient’s
support system? How are they involved in the Planning
patient’s care? What is the patient’s ability to For planning to be successful, everyone involved in
make medical decisions about his or her care? the decision must be included in the process.
Do financial considerations need to be taken Thompson and Thompson (1992) listed three spe-
into account? What does the patient value? cific and integrated phases of this planning:
What does the patient’s family value? The
answers to these questions will provide a better 1. Determine the goals of treatment. Is cure a goal,
understanding of the situation. Ask more ques- or is the goal to keep the patient comfortable?
tions, if necessary, to complete the picture. The Is life at any cost the goal, or is the goal a
social facts of a situation also include institu- peaceful death at home? These goals need to
tional policies, legal aspects, and economic be patient-focused, reality-centered, and attain-
factors. The personal belief systems of physicians able. They should be consistent with current
and other health-care professionals also influ- medical treatment and, if possible, be measura-
ence this aspect. ble according to an established period.
■ What are the cultural beliefs? Cultural beliefs play a 2. Identify the decision makers. As mentioned earlier,
major role in ethical decisions. Some cultures do nurses may or may not be decision makers in