Emergency Department Nurse’s ethical dilemma

Ethical dilemma
This essay will narrate a nurse’s ethical dilemma as experienced in a local emergency department. In addition, the paper will discuss the relevant codes of conduct and law and make recommendations based on the nurse’s ethical dilemma.
The subject in this case is a 93-year-old Alzheimer patient who was by then in an extended care facility. As the ailment worsened, she became unable to eat or drink anything, and this was a great threat to her health. It reached that point where the patient would not respond to any touch or voice. The physician in charge of her at this extended care facility had indicated that she would not thrive with that condition. The granddaughter to this ailing patient was the power of attorney. To make matters worse, the elderly patient had no advanced directive. The patient’s family had earlier been directed to send her to the emergency care department where she could be fitted with a feeding tube. If this was done, the patient would get better. So, the nurse was faced with the ethical dilemma of facilitating a diligent demise of the patient and at the same time balance the families’ wish (Heiser, 2014).
Ethical Principle 3 in Standard 3.2 deals with promoting and protecting the wellbeing of health consumers. It requires the health practitioner to respect the rights of the health consumers and their families, especially when it comes to participating in decisions about how they are cared for. The Nursing Council of New Zealand (2012) further emphasizes the need to put into account the priorities, needs and concerns of the health consumer and his family. If the nurse chose not to involve the family in deciding the fate of the Alzheimer patient, she would have grossly violated this ethical principle. And now that the patient herself was not in a position to give informed consent, the nurse turned out surprisingly ethical enough and involved the family.
It seems this nurse understood the legal risks that surrounded her while providing care. According to Reising (2012), nurses should do the following to steer clear of being sued for malpractice:
· Immediately the nurse observes some deviation in the health care, they should report this and supply any information required to the relevant authorities.
· Make accurate documentation of all nursing care, taking care not to chart anything ahead of time.
· Remain true to patients and their families, making sure to communicate frequently
· Check with other nurses in the event you delegated some tasks to them. Immediately report any abnormally observed in the patient.
· Always stay updated in what is happening in the nursing field, both within the organization and the work at large.
· Be well versed with your state’s nurse practice
Nursing Practice Acts (NPAs) are under the mandate of the state boards of nursing. These are the ones which give licenses to nurses and also determine which ones are competent enough to practice. We also have the common law, which is not a set of rules or regulations, but comprises general moral principles. The common law is based on common sense, reason and traditional justice. Nursing practice is built on both the NPAs and the common law. It therefore behooves the nurses to know the specific laws for the state they are licensed to practice in (USLegal, 2016). Assuming the nurse willfully allowed the elderly patient to suffer, the nurse would have committed criminal elder abuse. This is also committed when someone inflicts unjustifiable physical pain or even mental torture to an elder. It also covers the situation where a person willfully gets an elder to a position in which his health is compromised (Penal Code Section 368).
To avoid violation of the law, the best thing for the nurse would be to inform the concerned family about the worsening condition of the patient. As earlier stated, the power of attorney had indicated that a feeding tube would do the patient good. The family was also for the same idea. However, the nurse had this feeling that the family did not understand that Alzheimer is a progressive disease. It is in fact one form of Dementia that cannot be reversed. By providing nutrition, the patient’s quality of life would in no way improve. In such a case, the next step would be to consider the physical condition of the patient. But in our case, the patient was not in a position to make a decision, leave alone communicate her wish. Truth is that the 93-year-old had a stage III decubitus ulcer on her coccyx. And it is common knowledge that a feeding tube would in no way improve her quality of life. The nurse could perhaps try to open this truth to the family.
Recommendations
Blais & Hayes (2011) stated that responsible ethical reasoning calls for rational thinking. They further argue that it should not be based on intuition, emotions, precedents or fixed policies. The ethical principles outlaid by the various authorities must be considered, especially by nurses. Nurses are tasked with that great responsibility of promoting health, alleviating suffering and preventing illnesses. Nurses should therefore ensure the environment they operate from is health and safe from clients. They should also promote quality health care, by advancing their skills in the same. Systems rethinking helps the nurses achieve these goals (The International Council of Nurses, 2006).
So, in our current dilemma, it would be advisable to first place the feeding tube. This will at least convince the family member that their mother’s life will be prolonged. However, there no improvement at all because the Alzheimer had advanced to a no-return level. The family was not also aware of the fact that terminally ill patients refuse to eat and drink just as they are about to pass on. (Dreyer, Forde, & Nortvedt, 2009). Thus, the feeding tube idea was not at all a practical solution, but it just served to cool down the family. Emotions normally get out of hand during such moments, and so the family should be handled with extra care.
Another smart idea would be to propose hospice care for the Alzheimer patient. And whether the family agrees or disagrees, what matters is that they were involved in the decision-making process (Gladding, 2000). Apart from the nurse and the family, the following should also have been present in the discussion: a team of Physicians, a chaplain and a social worker. According to Dreyer et al. (2009), such tough discussions are normally done when emotions are at peak, since nurses will normally take time before communicating such eventualities. In most cases, such discussions take place while the patient is in an extended care facility. The ideal place to be would be under some hospice. Lastly, the nurse may consider sending the patient back to CEN. The family is likely to complain if this is done. They would claim their patient has been denied the much-needed care. This would also cause unnecessary delays in the care which the Alzheimer patient seriously needs. The nurse herself would not feel satisfied that she is caring enough for the patient (Heiser, 2014).


References
Blais, K., & Hayes, J. S. (2010). Professional nursing practice: Concepts and perspective (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Dreyer, A., Forde, R., & Nortvedt, P. (2009). Autonomy at the end of life: Life prolonging treatment in nursing homes - relatives’ role in the decision-making process. Journal of Medical Ethics, 35(11), 672-677.
Gladding, S. T. (2000). Counseling: A Comprehensive Profession (4th ed.). Upper Saddle River, NJ: Merrill.
Heiser, G. (2014). End of life ethical dilemma. Journal of Excellence in Integrated Writing Courses at Wright State, 1(7), 1-5.
International Council of Nurses. (2006). The ICN code of ethics for nurses. Retrieved from http://www.icn.ch/icncode.pdf
Nursing Council of New Zealand. (2012). Code of conduct for nurses.
Porth, C. M. (2010). Essentials of pathophysiology (3rd ed.). Philadelphia: Lippincott Williams& Wilkins.
Reising, D. L. (2012). Make your nursing care malpractice-proof. American Nurse Today, 7(1), 24–28.
USLegal. (2016). Nursing law and legal definition. Retrieved from https://definitions.uslegal.com/n/nursing/