NURSING ETHICAL DILEMMA 10
Thestate offers free medical services and life skills to patients ofmental conditions. The purpose is to ensure that the patients getquality medical attention and attain skills that can help them liveindependent of the help and support of others. The clinic I worked inoffered all round services to patients of different ages and theservices offered were entirely free. The broad scope of the clinicensured that the clinic had all the medical facilities and trainedprofessionals to deal with different medical situations of thepatients. My responsibility was to teach young children withintellectual disabilities.
Mymain duty was the care of patient A, who was a ten year old, and hehad a delay in acquiring self- care and self- help skills. Patient Awas brought to the clinic at the age of eight with severedisabilities in self- care as he had the mental capacity of a twoyear old child. The child developed various diseases over the yearsdue to the inability to adequately take care of himself. The parentscould also not find a competent person to take care of him. Patient Awas jovial, and he identified familiar people to him with a smile andclapping of the hands. When patient A arrived at the clinic, hesuffered from typhoid as he lacked self- control in what he ate.
Myrole was to train him simple life skills such as washing going to thetoilet when the need arose, cleaning his hands after visiting thetoilet, cleaning his hands before meals, eating clean foods,developing basic communication skills and following simpleinstructions. The role also included noting the progress of variousaspects of patient A’s health and social development. In caseswhere he developed difficulties that were beyond my assigned scope, Iwould report to the nurse- in- charge so that she would get thenecessary support for the patient. My role was thus to workcollaboratively with other health care practitioners to ensure thatpatient A received all the necessary support.
However,in more than one situation, I was asked to take care of other healthneeds of the patient beyond my scope and official working hours. Inone case, the patient suffered from typhoid as he had been exposed tostale food. This demonstrated negligence by the nutritional nurse ashe was supposed to ensure that the patient received fresh food withall the nutritional requirements as recommended by the patient’sdoctor. Once I noticed this negligence, I reported it to the nurse-in- charge who asked me to ensure that the child received his food ontime and that I took care of the nutritional needs of the patient.The second dilemma came when the nurse who was supposed to take ofthe medication requirements of the child was transferred to anothersection, and there was no replacement.
Accordingto ethical standards, all health practitioners involved in apatient’s care ought to work collaboratively so that patient A getsthe best health care possible (Hamric et al., 2014). The healthpractitioners ought to ensure that they each become activeparticipators in the health needs of the patient. Mental disorderpatients often require specialized care as their situation is oftenspecial, and all patients have unique needs. This means that thoseinvolved must have a deep understanding of each case and take activeroles in safeguarding the needs of each patient.
Inthis case, the ethical dilemma involved communication problems andmultiple commitments problems. The communication problems arose fromthe lack of proper coordination between the nurse in charge andmyself of the transfer of the nurse who was taking care of patientA’s typhoid problem. There was no managerial reason for the lack ofa replacement for the nurse. The nurse- in- charge ought to havecommunicated about the transfer as I would have made arrangements toadjust my schedule to accommodate new duties. Due to the lack ofcommunication, the patient missed one schedule of his medication asthere was no one to take care of the issue.
Inaddition to this, there was a communication problem about the nursein charge of nutrition. The kitchen department did not receive therequirements for the patient on time and the department thus did nothave food orders for the patient. This forced the department to lookfor alternatives for the patient, and the food found was stale. Thenurse in charge of nutritional needs did not verify the food given tothe patient. The nurse who was responsible for nutritional needs wasoff on that day, and he did not communicate this to the nurse- in-charge so that she could provide a substitute for the day.
Inthe second dilemma, I was forced to take up the roles of nutritionalneeds and medication. I thus had multiple commitments, and this meantthat I had to work for extra hours. The dilemma lay in whether Iwould just play my role and leave the rest or whether I would take inall the responsibilities even when I would not get paid for the extraduties and time that I had to put in (Hamric et al., 2014). This wasa self- care problem as outlined by Nightgale as I would end upexhausted and overworked. I was supposed to ensure that the childachieved basic self- help skills, and this required an all- roundcare for a successful outcome. The decision to take up all theresponsibilities thus lay in the interest of the patient.
Accordingto nursing ethical standards, the nurse must always ensure that thepatient’s interests are taken care of for the purpose of completehealing. The ethical standards recognize that the patient cannotachieve physical health if other aspects such as nutrition are notaken care of adequately (Hamric et al., 2014). The interests ofmental disorder patients are especially important as they deal withensuring that the patient achieves basic skills that help him to fitwithin the society with as much ease as possible. The requirement isthat the patient gets quality health care, and the purpose of theclinic was to ensure that this was achieved by providing free carefor mental disorder patients.
Thedecision to put in extra hours and take up extra responsibilitiesrequired personal ethics as outlined by Nightgale. Every health careinstitution has a duty to ensure that its employees work in safesituations, and this includes taking care of the health needs of theemployees. The ethical dilemma involved choosing to take care of myresponsibilities only as this was my official duties and neglectingthose that were not in my scope. This is because the nurse- in-charge was responsible for assigning duties to the respectivedepartments and people. According to the clinic’s guidelines, thenurse- in- charge would bare personal responsibilities in cases ofnegligence due to situations as mine. However, according to personalethics, the nurse ought to also consider the needs of the patientwhen offering services.
Thesituation resulted in the violation of a number of nursing principlesincluding the beneficence, fairness, and non- maleficence. The nurseis supposed to practice ethical considerations and professionalism atall times, and when either of these is violated, it demonstrates alack of ethical principles. The beneficence principle requires nursesto do good at all times. Nurses have a professional and ethicalrequirement to do good even if it is beyond their scope. Thepatient’s health is important and thus, there ought to be a middlepoint between the needs of patient A and those of the nurse (Hamricet al., 2014). In this case, a nurse- in- charge neglected to do goodby finding temporary replacements for nutritional and health carenurses. The nurse was supposed to ensure that there were qualifiedsubstitutes instead of heaping more duties on the nurse in charge ofthe intellectual problems of patient A.
Accordingto the nurse in charge, she could not get replacements as she had notmade requests within the stipulated timeline of two days in advance.According to the principle of beneficence, the nurse- in- charge hadthe duty to ensure that the welfare of the patient took precedence bymaking a request for substitutes or requesting the nurses in chargeof the nutritional and physical health of patient A. This wouldensure that the beneficence of the patient was well covered, as itrequires health practitioners to do good as an ethical principle. Onthe other hand, I ensured that I upheld the principle of beneficenceby doing what was good despite the fact that I had a choice to lookout for my needs first since the blame would not be on me.
Fairnessrequires that health facilities treat their patients and employeeswith fairness as it ensures that the rights of everyone are covered(Hamric et al., 2014). In this case, the fairness to patient A wasviolated as he had a right to proper food despite the fact that hisorder had not been placed on time. The nutrition department had theethical duty of facilitating a healthy meal for the patient despitethe circumstances. My right to fairness was also violated as I tookon the duties of other nurses with no allowance or consideration tomy schedule. Fairness requires that the well- being of the nurse isalso considered to ensure that the nurse gets enough rest and well-remunerated for her role.
Theprinciple of non- maleficence holds that nurses ought to do no harmto a patient regardless of the situation. The health of the patientmust be given priority during decision- making and must be protectedat all times (Hamric et al., 2014). The kitchen department violatedthis principle by giving the patient stale food even if his order hadnot been placed. It was the responsibility of the matron to ensurethat patient A got healthy food despite the circumstances. The harmwas also done when the patient failed to receive his medication ontime because the nurse in charge had been transferred. The departmentought to have made prior arrangements to ensure that the patient waswell- supported before getting a replacement. In this case, puttingme in charge upheld the principle of non- maleficence because thedecision was made to ensure that the level of harm was reduced.
Thebiggest barrier to ethical practice in this case was a lack ofcommunication. There was a clear failure of communication between allthe people who were tasked with ensuring that the welfare of patientA was upheld. The nurses failed to communicate with the nurse- in-charge on time, who then failed to communicate with me and theresponsible departments on time. Lack of efficient communication cancause unethical practices such as the case where the nurse- in-charge heaped all the responsibilities on me.
Anotherbarrier was the lack of support from the nurse- in- charge. A patientwith intellectual disabilities requires to be closely monitored asany illnesses, or lack of proper treatment can slow down the progressof the patient. The nurse in charge did not support my duty to trainthe child by neglecting to communicate about the lack of the othernurses who were involved in the case, on time. This resulted inillness, which affected the health of the child and thus, thetraining had to slow down and a priority was given to the health ofthe patient. This also demonstrated an inadequate staffing scheduleof the clinic. This led to unethical practices where the fairness ofthe patient and I were denied.
Ifthe situation occurs again, I will use the utilitarianism theory toguide me in my decisions about what to do. According to the theory,ethical decision is one that yields the largest benefit to as manypeople as possible. The outcome of a situation is thus a guide towhat is correct in any given situation. Nursing practitioners mustensure that their actions yield the most benefit to all the peopleinvolved. The field involves taking care of the need of all patientsin any given situation to one’s best ability (Hamric et al., 2014).Act utilitarianism holds that one’s actions ought to benefit themost number of people regardless of one’s feelings about thesituation or existing laws.
Ifthis situation arose again, I would ensure that I do what is fair bytaking on responsibilities that were not assigned to me so that thepatient would not suffer due to negligence (Hamric et al., 2014).This is despite the fact that I feel that this would be unfair to meas the duties would require me to put in extra, unpaid work. The lawsof the clinic also allow me to reject extra duties as it is not myduty to make sure that the clinic is well staffed. However, ethicalconsiderations require that I take care of patient A beyond my scopeas this is the fairest thing to do at any given time.
Ingeneral, I was disappointed that I had to work extra time and putmore effort because other people rejected their responsibilities. Ialso thought that the nurse- in- charge and all those involved incausing harm to the patient A ought to have been punished for theiractions. I was also disappointed that the clinic did not have anallowance for nurses who put in extra time and effort as this oughtto be remunerated. However, if the situation occurred again, I wouldstill put in extra time and effort as this is the ethical thing todo. Nurses are not supposed to let patients suffer just because theirillnesses or situations did not fall within their scope.
Inconclusion, the nursing career is guided by a set of ethicalprinciples that are supposed to cover the interests of the patientsand nurses. The Nightgale guideline on ethical dilemmas for nursesprovided an outline of ethical considerations that covered on theinterests of the nurses and the patients. In the case of patient A,there was a violation of various ethical standards due to poorcommunication and lack of support from the nurse- in- charge. Thisresulted in the violation of the principles of fairness, beneficence,and non- maleficence. The patient was at the clinic to learn basicself- help and self- care skills as he had an intellectualdisability.
Asthe child was at the clinic, he acquired typhoid due to negligenceand then the nurse who was taking care of his medication wastransferred without my knowledge while the nutrition nurse went on anoff. The nurse- in- charge thus put me in charge of both duties. Thesituation disappointed me as it meant that I had to put in extra workand time with no extra pay until a replacement was found. However, Iput in more work because according to the theory of actutilitarianism, a nurse must ensure that her work benefits as manypeople as possible despite personal feelings or legal requirements.
Hamric,A., Hanson, C., Tracy, M., & O`Grady, E. (2014). Advancedpractice in nursing. An integrative approach.St. Louis, Missouri: Elsevier Saunders.