You have been working as a nurse in the adult oncology unit for the past year. You have developed a close relationship with many of your patients, but Mr. Newcomb has a special place in your heart
The purpose of this task is to explore how nursing ethics, self-advocacy, and professional accountability can be applied in clinical practice. Using the provided case scenario, you will be required to think about how ethical concepts can be used to make clinical decisions and explore the differences in personal and professional beliefs. You will develop personalized stress management plans that rely on the use of adaptive coping strategies to ensure personal health and well-being.
You have been working as a nurse in the adult oncology unit for the past year. You have developed a close relationship with many of your patients, but Mr. Newcomb has a special place in your heart. He has been diagnosed with stage 4 pancreatic cancer and has undergone aggressive chemotherapy. Each day his wife has come to the unit to be with her husband. They have been married for over 40 years and share a deep love.
Mr. and Mrs. Newcomb have made the decision to no longer continue with treatment and have decided that hospice care is needed. Over the past few days, you have watched Mr. Newcomb’s health decline, and you can tell from your experience that he does not have much time left to live. Mr. Newcomb has been very open about discussing his death, and you have had the opportunity to learn about his life and the legacy he will leave behind.
While you are completing your rounds, you stop in Mr. Newcomb’s room to see how he is doing. You ask, “Is there anything else I can do for you?” Mr. Newcomb has rarely asked for anything, but today he has one request. Mr. Newcomb states, “Before I die, I would like to see my mistress one more time. Mrs. Newcomb is always here. Do you think you could tell her that I will be busy for a few hours tomorrow so I can make arrangements to see my mistress one more time?”
Reflect on the following questions before you begin working on this task:
• What would you do in this scenario?
• How can your knowledge of ethical principles be utilized to determine your response to Mr. Newcomb?
• How would this affect you as a nurse and direct provider of care for Mr. Newcomb?
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A. Summarize how the principles of beneficence, non-maleficence, autonomy, and justice apply to the scenario by doing the following:
1. Describe how you would respond to Mr. Newcomb’s request.
2. Evaluate how you applied the principles of beneficence, non-maleficence, autonomy, and justice to the scenario.
3. Examine how personal beliefs and values influenced your response to the scenario.
4. Describe three strategies to promote self-care.
B. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
C. Demonstrate professional communication in the content and presentation of your submission.
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
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NOT EVIDENT A description is not provided, or the description makes no reference to how the candidate would respond to Mr. Newcomb’s request. |
APPROACHING COMPETENCE The description of how the candidate would respond to Mr. Newcomb’s request is irrelevant. |
COMPETENT The description of how the candidate would respond to Mr. Newcomb’s request is relevant. |
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NOT EVIDENT An evaluation is not provided, or the evaluation makes no reference to how the candidate applied the given principles to the scenario. |
APPROACHING COMPETENCE The evaluation inaccurately addresses how the candidate applied the given principles to the scenario or is not supported. |
COMPETENT The evaluation accurately addresses how the candidate applied the given principles to the scenario and is supported. |
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NOT EVIDENT An examination is not provided, or the examination makes no reference to how personal beliefs and values influenced the candidate’s response to the clinical scenario. |
APPROACHING COMPETENCE The examination of how personal beliefs and values influenced the candidate’s response to the clinical scenario is irrelevant or not supported. |
COMPETENT The examination of how personal beliefs and values influenced the candidate’s response to the clinical scenario is relevant and supported. |
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NOT EVIDENT A description is not provided, or the description makes no reference to three strategies to promote self-care. |
APPROACHING COMPETENCE The description of three strategies to promote self-care is irrelevant. |
COMPETENT The description of three strategies to promote self-care is relevant. |
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NOT EVIDENT The submission does not include both in-text citations and a reference list for sources that are quoted, paraphrased, or summarized. |
APPROACHING COMPETENCE The submission includes in-text citations for sources that are quoted, paraphrased, or summarized, and a reference list; however, the citations and/or reference list is incomplete or inaccurate. |
COMPETENT The submission includes in-text citations for sources that are properly quoted, paraphrased, or summarized and a reference list that accurately identifies the author, date, title, and source location as available. |
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NOT EVIDENT Content is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic. |
APPROACHING COMPETENCE Content is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective. |
COMPETENT Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding. |
Expert Answer and Explanation
Using Ethical Principles to Guide Clinical Decisions
Clinical practitioners interact with patients with diverse needs, and in the event of interacting with these patients, they encounter situations in which they have to make decisions that can have ethical repercussions. Situations of this kind require a clinician to make decisions while considering the needs of their patient, and the practice guidelines which dictate provider’s behaviors.
In extension, they have to consider the needs of the patient’s family. For a practitioner, making decisions can be a challenge especially where the patient’s makes demands which contradict the demands of their family. For a provider to effectively manage a case of this nature, it is important that they apply the ethical principles, and assess this issue based on the perspectives of these principles (Schröder-Bäck et al., 2019). This study explores the means of managing a case in which a palliative care patient makes a request to see his mistress, and highlights ethical principles as they apply in the case.
Responding to Mr. Newcomb’s Request
Mr. Newcomb’s case raises contentious ethical issues which one can resolve by analyzing the problem in the perspectives of the nurse code of ethics as well as the ethical principles. Looking at this issue based on the code of ethics, it is insensible to honor the request of this patient. This is because although this code compels nursing practitioners to respect the wishes of their patients, there are reservations to this code. It does not apply where the request touches on the patient’s personal life.
Due to Mr. Newcomb’s health, he needs an end of life care which meets his wishes to improve his experience as he dies. As a provider however, there are limits to the patients’ requests I can meet. My professional values compel me to respect the feelings of the patient and those of their family (Byrd & Winkelstein, 2019). Therefore, I will not make a decision that would compromise my relationship with Mr. Newcomb’s wife.
Application of the Ethical Principles
The ethical principles can guide decision-making process in the case of Mr. Newcomb. Autonomy is part of these principles. According to this principle, Mr. Newcomb can choose what he feels is best for him. Accordingly, I will let Mr. Newcomb decide what he feels is best for him without judging this patient. Since this request conflicts my views of what is moral, I will decline Mr. Newcomb’s request. Beneficence provides an additional principle for examining the problem that arises in case study.
This principle compels a provider to promote happiness, and this case therefore, they would realize this by honoring Mr. Newcomb’s request. Unfortunately, his request does not constitutes an essential part of his treatment. Based on the non-maleficence principle, failing to respect the needs of a patient may amount to causation of harm (Bradley, 2017). However, the request the patient places does not in any way relate to his health care. Thus, the ethical principles only apply where the patient raises genuine concerns which affect their health.
The various moral principles provide the perspectives for resolving the ethical dilemma which presents in the case study. Autonomy is part of these principles. It compels a provider to respect the decisions their patients make. In this case, I will respect Mr. Newcomb’s request. Beneficence provides another perspective for looking at the moral issue. Based on this principle, a provider has the mandate of acing in a way that their actions would benefit the patient.
In this case, the patient would benefit if he gets to see his mistress. It will improve his experience of care. Non-maleficence also calls on the interventionist to avoid harm on the other. To avoid this harm as a provider, it is important to call the mistress and inform her about Mr. Newcomb’s wishes.
The principle of justice offers a view on how to address the dilemma in Mr. Newcomb’s case. According to this principle, individuals should act in a way that their actions would be fair. It would be unfair to engage in actions which may hurt Mr. Newcomb’s wife. It is unfair to lie just to meet patients’ expectations because the principle of justice compels providers to be honest.
Impact of Personal Beliefs and Values on the Scenario
Certain key values shape how I respond to the case. I expect individuals to be honest as well as confidential. When a caregiver is honest, they would be truthful to their patients as well as to the patient’s family about the health of these patients. For this reason, honoring the request of this patient would amount to dishonesty, and based on the professional codes, it is unethical to act in such a manner. It is important to keep secret the details of the personal life of Mr. (Mills, Wand, & Fraser, 2018). Newcomb.
Being honest with this patient will prevent a scenario where the feelings of Mr. Newcomb’s wife becomes hurt (El Rhazi, & Adarmouch, 2020). When making decisions, therefore, I will try to be honest, and make decisions which do not compromise my relationship with the patient’s family. This resonates with my belief concerning confidentiality. Consequently, I would not meddle in his personal affairs out of respect for the wife (Agorastos, Demiralay, & Huber, 2019).
Strategies for Promoting Self-Care
Certain key strategies can be effective in helping Mr. Newcomb manage his own health with limited provider involvement. Exercise is part of these strategies. Using this particular strategy, Mr. Newcomb would be able to attain the physical and mental wellbeing. This will ultimately help improve the quality of his life. Another strategy involves dieting. With this strategy, the patient eats healthy foods, and this can help limit his risk of becoming ill. Building social relationships and maintaining a positive work-life balance, can help improve his emotional wellbeing.
Conclusion
In conclusion, the principles of ethics can help providers resolve a situation sin which patients’ demands become raise ethical issues. These principles can only apply where the patient’s concerns are genuine. This means that these principles do not apply in matters involving the personal and private life of the patient. A provider’s personal beliefs can also affect how they respond to the requests which a patient makes. It is reasonable for a provider not to honor the demands pertaining to the patient’s personal life if these demands do not conform to the provider’s own values.
References
Agorastos, A., Demiralay, C., & Huber, C. G. (2019). Influence of religious aspects and personal beliefs on psychological behavior: focus on anxiety disorders. Psychology research and behavior management, 7, 93–101.Doi: https://doi.org/10.2147/PRBM.S43666.
Bradley, L. (2017). Non-maleficence: perspective of a medical student. The British journal of general practice : the journal of the Royal College of General Practitioners, 67(659), 252. Doi: https://doi.org/10.3399/bjgp17X691001.
Byrd, G. D., & Winkelstein, P. (2019). A comparative analysis of moral principles and behavioral norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions. Journal of the Medical Library Association : JMLA, 102(4), 247–256. Doi:https://doi.org/10.3163/1536-5050.102.4.006.
El Rhazi, K., & Adarmouch, L. (2020). Ethical issues related to the hydroxychloroquine treatment prescription for Covid-19. Ethics, medicine, and public health, 14, 100547. Doi:https://doi.org/10.1016/j.jemep.2020.100547.
Mills, J., Wand, T., & Fraser, J. A. (2018). Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study. BMC palliative care, 17(1), 63. Doi: https://doi.org/10.1186/s12904-018-0318-0.
Schröder-Bäck, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2019). Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes. BMC medical ethics, 15, 73. Doi:https://doi.org/10.1186/1472-6939-15-73.
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