Summarize in 500 – 600 words a nursing experience when you faced an ethical dilemma and discuss any emotions or moral distress you experienced. Describe the setting and individuals involved as well as how the individuals or groups perceived the problem. Identify conflicting values and beliefs at the individual, organizational, and societal levels that influenced perceptions of the people involved in the experience. Provide assessment data or information about the situation that might have been helpful. Describe how additional information could be obtained and the resources available. Cite references if used. Do not submit as an attachment and do not exceed 600 words.
Using the Model of Culturally Competent Ethical Decision Making, redefine and make recommendations in 250 to 300 words to correct the dilemma using the concepts of cultural context and cultural competence as well as compassion, social justice, human rights and partnership, collaboration and advocacy. This model can be found in Chapter 14 of the Andrews & Boyle text. This chapter is accessible through thePoint, please refer to the inside cover of the Andrews & Boyle text to register the textbook and have access to this information. At least one reference must be cited, and do not exceed 300 words.
Ethical Dilemma
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Ethical Dilemma
Part 1: A Description of an Ethical Dilemma Scenario
Healthcare providers who are working with patients experiencing extreme duress such as those with life-threatening conditions are highly likely to face ethical dilemmas during practice. Giannetta et al. (2021) define an ethical dilemma as a situation where one is required to make a decision concerning an issue that has conflicting moral values. An ethical dilemma I once experienced involved an 82-year-old female patient who had lived with breast cancer for 6 years. The patient was diagnosed with breast cancer at the age of 76 years and she was on medication to manage the disease at the time of her visit. The patient was hospitalized due to complications that she developed three days ago. I met her on the second day of hospitalization. The physician had recommended that a mastectomy should be conducted on the patient to remove her left breast as this will help to relieve her of the severe pain she was experiencing and improve her quality of life. However, the mastectomy would not prolong her life much because she had a prognosis of about six months to live. The patient was against the doctor’s decisions citing that mastectomy is costly and will subject her to even more suffering yet she only had a few months to live. Her wish was to undergo physician-assisted suicide claiming that the practice is legal in her state Washington and that she met the conditions set for terminally-ill patients to get a prescription for the required medications.
The ethical dilemma that I faced in the scenario was whether to advise the patient to undergo a mastectomy to reduce her pain or encourage her to consider physician-assisted death. Depending on the moral grounds taken by the decision-maker, either of the actions will alleviate the patient from suffering, but what is the best action to be taken by a nurse caring for the patient? The patient’s daughter aged 45 years and son aged 40 years were both present in the ward. Both of them were saddened by their mother’s decision as they were ready to support her through her illness. Their request was that I convince their mother to undergo a mastectomy.
The moral distress in the scenario was attributed to the fact that the patient’s values and beliefs were conflicting with those of her children and the nurse. At the individual level, the patient was against mastectomy because she believed that it is costly and will subject her to even more suffering yet she only had a few months to live. However, the doctor’s values and actions are guided by a professional code of conduct that emphasizes the physician’s role in promoting healing. At the organizational level, the facility’s mission is to provide quality care to patients across the lifespan in order to improve their quality of life. The patient’s stand will, however, prevent the organization from realizing its mission. Additionally, the patient’s values and beliefs are contradicting society’s wish to see people recover from sickness including those with terminal illnesses. After conducting a comprehensive assessment of the situation, the most helpful information that can guide decision-making is that the values and beliefs of the healthcare providers, the organization, and the society support actions that will promote healing and improve quality of life but not actions that promote death. When faced with a similar situation in their practice in the future, nurses should consult resources that discuss how ethical principles can be applied to guide decision-making in situations of ethical dilemma or moral distress.
Part 2: The Application of Andrews and Boyle’s Model of Culturally Competent Ethical Decision Making
The wish of many patients diagnosed with a medical condition is to get the best treatment possible in order to recover from their conditions and have an improved quality of life. However, it is important to note that this is not always the case for all patients diagnosed with cancer (Wajid et al., 2022). Even when faced with an ethical dilemma, healthcare professionals are expected to observe ethics by making a decision that is supported by clear ethical principles. Andrews and Boyle’s Model of Culturally Competent Ethical Decision Making provides a good framework for nurses who are faced with an ethical dilemma like the one described above.
Using Andrews and Boyle’s Model of Culturally Competent Ethical Decision Making, the nurse should apply the concepts of cultural context and cultural competence as well as compassion, social justice, human rights and partnership, collaboration, and advocacy to the scenario to address the dilemma. The nurse should begin by evaluating the cultural context surrounding the scenario. Although the patient’s values and beliefs contradict the doctor’s decision, the nurse should demonstrate cultural competence by making her feel valued through cultural repatterning to enable her to understand the need to consider mastectomy in place of physician-assisted death (Andrews & Boyle, 2019). Additionally, the nurse should show compassion, respect the patient’s right to choose the preferred type of care, and demonstrate social justice by helping the patients to access care that will alleviate pain, eliminate suffering and improve quality of life. Part of the nurses’ role is to advocate for the creation of health systems that can help a patient to achieve quality health outcomes (Andrews & Boyle, 2019). By partnering and collaborating with other nurses and healthcare providers, the nurse can help the patient to choose a care path that will promote life but not death.
References
Andrews, M. M., & Boyle, J. S. (2019). The Andrews/Boyle Transcultural Interprofessional Practice (TIP) Model. Journal of Transcultural Nursing, 30(4), 323–330. https://doi.org/10.1177/1043659619849475.
Giannetta, N., Villa, G., Pennestrì, F., Sala, R., Mordacci, R., & Manara, D. F. (2021). Ethical Problems and Moral Distress in Primary Care: A Scoping Review. International Journal of Environmental Research and Public Health, 18(14), 7565. https://doi.org/10.3390/ijerph18147565
Wajid, M., Rajkumar, E., & Romate, J. (2022). Exploring the end-of-life experiences of advanced cancer patients from India. Health Psychology Research, 10(3), 36272.