lnquiry for Professional Practice
Ethical Decision-Making Framework
The purpose of this assessment is to identify the principles of professional nursing practice, outline the ethical and legal frameworks for professional practice and apply the IVIodel for Ethical Decision-tVlaking to a complex scenario in order to establish an ethically and legally sound decision. Using the Model for Ethical Decision-Making (as cited in Staunton and Chiarella, 2017, p.31-32) for the case scenario listed below determine the most favourable outcome for the patient.
You are required to use headings as per the Model for Ethical Decision Making:
1. Clearly state the problem
2. Get the facts
3. Consider the fundarnental ethical principles
4. Consider how the problem would look from using another theory
5. ldentify the ethical conflicts
6. Consider the ldw
7. Make the ethical decision
8. Evaluate the decision
Remember to incorporate evidenced-based practice in relation to quality patient care. You MUST consider the following:
Health Practitioner Regulation National Law (WA) Act 2010
Registered nurse standards for practice
Code of conduct for nurses
lnternational Council of Nurses Code of ethics for nurses
National Safety and Quality Health Service Standards
ln addition, you need to include relevant Australian Acts and Laws relating to the subject and health care practitioners. Ensure academic format with appropriate referencing as per APA referencing style. It is the student's responsibility to ensure the correct version of assessment is submitted before the due date.
Please refer to Assessment 2: Ethical Decision-Making Framework rubric. The word count for this assessment is 1800 words.
lnquiry for Professional Practice
Ethical Decision-Making Framework
Assessment 2 CASE SCENARIO
I I am the Recovery Roory Nurse Joan handing over the care of Fred Robinson to you, registered nurse on the Coronary Care Unit. Fred's futRN is H546983 and his date of birth is 8/10/1948.
S Fred was admitted for a Transurethral Resection (TUR), due to difficulty with urination, this morning. The procedure was aborted in the operating room when he developed cardiac changes following the spinal anaesthetic. He was returned to the recovery room with the diagnosis of possible myocardial infarction. Fred went on to go into ventricular tachycardia/ventricular failure (VTA/F) and needed defibrillation x3, cardiopulmonary resuscitation (CPR), intubation, lidocaine and vasopressors to maintain his blood pressure (BP)
O Temperature 36.1 . Pulse 130 bpm, sinus tachycardia. Respiratory rate 20 breaths/min ventilated with 1A0% oxygen, o2Sa 92%. BP 7614A mmHg, maintained with lV dopamine, 26 mcg/kg, and lV dobutamine, 8 mcglkg. Fred is occasionally responding to verbal commands, responding to pain. Fred is being kept alive by the ventilator and medications.
B Fred has a history of previous myocardial infarction (lVl) and cancer of the prostate, which has caused his difficulty with urination. Fred was a builder for 45 years, with his own business and is now officially retired. His only son took over the business and Fred continues to help him out on a part time basis. Fred's wife died last year. Fred's son is his next of kin. Following the code an attending cardiologist, Dr Diamond, recognised Fred and stated to the nursing and medical staff, "l know him from his last hospitalisation. I think he has an Advance Health Directive (AHD)." A relative who works in the hospital has been contacted and also expressed the belief that Fred has an AHD. We haven't been able to contact Fred's son as yet. However sn review of the notes, we have found a "Not for Resuscitation (NFR)" formed signed by a doctor and Fred from his last admission.
A So the plan is for Fred to be moved to the eCU. The medical team will continue to try and contact Fred's son. Fred will be reviewed as soon as you return to the CCU with him to decide whether to continue with conservative management, ventilation and medication, until the AHD can be located or whether treatment should be slowly withdrawn.
R I will contact the doctors now to let them know you are transferring Fred now You should let your unit manager know what is happening. Using the Model for Ethical Decision-Making consider what is 'in the best interest'of Fred utilising legal and ethical principles and professional and safety standards to make your decision.
Ethical decision making framework
State the problem
Fred Robinson is suffering from urination problem and admitted to the hospital for transurethral resection (TUR) purpose. The procedure of resection has been aborted due to cardiac changes in Fred. The doctors have suspected that he might havethe complication of myocardial infarction. The doctors have identified that he is suffering from ventricular tachycardia which requires CPR, defibrillation x3 and vasopressors for maintaining his blood pressure. The clinical manifestation of Fred suggested that his body temperature is lowered and pulse rate is increased due to a certain attack. In addition, his BP is fallen down and suffering from low blood oxygen. Thus, he is treated with IV dopamine and IV dobutamine. Dopamine can improve the functional capacity of the heart by increasing the pumping process and maintaining the blood flow towards the kidney. Additionally, dobutamine is used to treat acute heart failure. At present, he is in a partial unconscious state and responding to pain only. In this condition, ventilation and meditation can only save his life.
Furthermore, Fred requires immediate attention but his only son is unreachable and the cardiologist Dr. Diamond recognised that he was already signing the advance health directive (AHD) and not for resuscitation (NFR) forms which indicated that he already made specific instruction about his illness and selected his way of treatment. In addition, the signing of not for resuscitation implies that he suggestedfor avoiding CPR. Now the doctors and nurses are in an ethical dilemma to respect the decision of the patient and to continue the life-saving treatment of him(Salins, Pai, Vidyasagar &Sobhana, 2010). Therefore, the authority has been decided to shift him in CCU,until the AHD will be available or his son response to his hospitalisation.
Get the facts
The past medical history of Fred suggests that he is suffering from myocardial infarction and prostate cancer. During the process of transurethral resection, he develops cardiac attack which causeslife threatening situation for him. His wife died in last year and his only son is taking care of him. However, he decided to sign AHD which provides basic information about him and his preferences about treatment. In this emergency situation, the medical team requires toget in touch withhis son for making a decision in his treatment procedure or find out the AHD forms for better intervention process.
In myocardial infarction, the plaqueis developed in the coronary arteries which hindering the blood flow. Therefore, AHD forms can help us to identify the severity of the illness and the medical professionals can take the correct decisions(Qld.gov, 2018). In the case of Fred, myocardial infarction can reduce the blood flow to the heart and cause severe tissue damage. As a result, Fred develops ventricular tachycardia which reduces his body temperature, increases his pulse rate and shortness of breath along with dizziness and fainting. However, the ventricular tachycardia can be classified into four categories depending on the basis of duration of the episode, morphology, and hemodynamic effect of the blood (Tang, Do, Li & Boyle, 2018). It can be dangerous for the person suffering from heart disease, previous history of heart attack and old age adults. In an emergency situation, the condition can be improved by the application of CPR, electrical defibrillation, anti-arrhythmic drugs, and electrical shock. In the long term process of treatment, the application of implantable cardioverter defibrillator can be beneficial which can rectify the abnormal heart rhythm (Tang, Do, Li & Boyle, 2018). In addition, radiofrequency ablation can be useful measures which destroy the abnormal tissues in the heart by electrical current those are responsible for abnormal heartbeats. Furthermore, cardiac resynchronisation therapy can be implemented to regulate the heartbeat. If the condition is untreated then the risk of cardiac arrest and other serious condition is increased in manifolds (Tang, Do, Li & Boyle, 2018).
Consider the fundamental ethical principles
The fundamental ethical principles are autonomy, nonmaleficence, justice, fidelity, beneficence, and paternalism. These principles are essential for ethical decision making process in the healthcare profession("The importance of professional standards", 2014).
It allows the medical professional to respect and support the decision of the patient in refusing the life sustaining treatment. The healthcare professionals should explain the whole scenario of the disease and complications to the patient and respect their decision and plan according to their wishes. In the case of Fred, his decision about resuscitation is recognisedand respected by the professional and immediately put him on ventilation and medication (Section 10: Guideline 10.5 - Legal and Ethical Issues Related to Resuscitation, 2015).
It is used for the selection of intervention process which causes minimum harm to the patients and providesa better outcome (Western Australian Legislation, 2010). In this process, patient privacy is maintained along with patient safety (Lee & Cassel,1984). In the case of Fred, he is immediately transferred to the CCUfor better care and services until his AHD forms locate.
It can be defined as an actionguided by compassion. The healthcare professionals can control the condition by administration of medicine and support the family member. The emergencycondition of Fred is controlled by taking immediate action and supporting his mental and physical situation. However, the medical personnel is trying to contact his son for informing the situation (Nursing midwifery board, 2017).
It can direct the healthcare professionals to provide care with honesty, caring and loyalty. In this respect, the positive relationship between the patient and caregivers should be maintained for better care and services. In addition, identify the supportive care and services for improving the patient condition. In the case of Fred, it has been maintained by avoiding his CPR (Health Practitioner Regulation National Law (ACT), 2018).
It can assure that the care is providing on fair and equal basis despite patient’s social and financial background. In the case of Fred, the healthcare professionals are prioritising his health condition and take immediate action (Code of ethics for nurses in Australia, 2002).
It can provide the power to the healthcare professionals about decision making and potential treatment modalities (Hicks, Merritt & Elstein, 2003). In the case of Fred, an interdisciplinary team meeting about the future treatment process with his son can be attempted for a better result.
Consider how the problem would look from using theory
The deontological theory suggests that the actions are intrinsically wrong or right. The theory believes that the acts are obligatory despite their consequences (Misselbrook, 2013). Therefore, the theory is termed as a formalistic theory as the principle lies in the conformity of action to some laws and rules (Western Australian Legislation, 2010). The theory supports the thoughts of human rights and norms. As per the deontologists, one cannot perform immoral acts which torture the individual even the outcome can be morally preferable. The Greek word does mean right or obligation. In the deontological system of ethics, the consequences of an action are considered as irrelevant to moral assessment (Playford, Roberts & Playford, 2014).
In the scenario of Fred, the medical professional finds out that CPR can be beneficial for him but as he was signing the not for resuscitation forms, they avoid to apply CPR and choose another way of treatment. The medical professionals are showing respect towards human rights and preferences which is supported by the deontological theory.
Identify the ethical conflicts
The ethical conflicts of healthcare professionals are:
Healthcare professionals can face conflict in their own morals and values in treating the patients. The professionals are bound to provide the highest standard of care and services essential for the emergency situation. However, they need to respect the thoughts and beliefs of the patients despite disagreement(Ray, 2019). Fred is suffering from ventricular tachycardia which requires CPR but his disagree is respected and transfer him in ventilation.
Informing the situation or sharing the treatment process and disease prognosis with the patient and their families is another difficult aspect. Healthcare professionals should carefully handle the situation to make the patient and their family comfortable and assure. In this respect, the professionals can feel an ethical dilemma in explaining the decision making process(Hall, Prochazka& Fink, 2012). In the case scenario, the medical professionals are trying to contact with Fred’s son for explaining the situation of his father and preparing a treatment strategy for him which can improve his condition.
Consider the law
Advance health directive (AHD) or not for resuscitation is a process through which the patient can authenticate their own preferable standpoint (Section 10: Guideline 10.5 - Legal and Ethical Issues Related to Resuscitation, 2015). The authenticated comments should be recorded in the patient’s clinical record. In an emergencysituation, the consent can be considered for the future treatment planning purpose (Punjani, 2013). Through this process of authentication, the patient can select the legal authority for them who can take decision instead of them(Human rights, 2019). Therefore, healthcare professionals are bound to follow the wishes of the patient’s and show respect towards their decisions. The decisions can be changed by the legal authority or the patient itself(Australian Resuscitation Council, 2015).
Registered nurses should think critically about the strategies for providing safe and quality services. The nurses should engage with therapeutic and professional relationships which can create trust and respect. They are responsible for evaluating practice basedservices. They can able to analyse the information, data and communicate accordingly for a better result. They are responsible for providing safe and appropriate quality nursing practice to their patients and create partnership. In addition, they are responsible for the planning and communication of nursing practice. The nurses are responsible and accountable for ensuring safe care and better services(Nursing mid wifery board, 2017).
Make the ethical decision
The scenario can examine the ethical issues that arise when the goal of services is the active and compassionate care for dying person or closet to the situation. In this respect, ethical principles are applied for better results. In addition, healthcare professionals should discuss with the family and friends of the patients about the future goal and planning (NSQHS, 2019). These kinds of discussion are essential for the patient who becomes suddenly ill or injured.
Analysis of the ethical and legal consideration
In this respect autonomy and self determination are the ethical principles which are relevant to the scenario of Fred. He has been decided to avoid CPR and have AHD which needs to be addressed before starting the treatment process. As per the fidelity, it is essential to support the patient’s thoughts to the end(CARNA, 2010). In this respect, the healthcare team can work together with his son and family relatives to find out the superlative path of treatment to support his desire. Therefore, the ethical principle of beneficence suggests that the patients must receive a positive outcome from the healthcare interventions(Qian et al., 2013). Thus, the patient’s wish should be considered in making decisions about his intervention process. In addition, the ethical principle of non maleficence suggests doing not harm the patient and withdrawal all the practice which are not permitted by the patient (Human rights, 2019). The legal authority can act on behalf of the patient and take a decision in his critical condition. In the case of Fred, if he was not assigning anyone in legal authority then his decision will be considered as the last decision(Human rights, 2019).
Discuss the options
At present Fred is admitted to the CCU for ventilation and medication purpose. After communicating with his son and checking the AHD the healthcare professional will find out the exact treatment process which can be beneficial for him (Human rights, 2019). However, the registered nurses are bound to provide care and support to their patient at the end of life.
Evaluate the decision
The Australian commission developedthe NSQHS standards for maintaining safety and quality in health care facilities (NSQHS, 2019).The main aim is to provide better quality service in healthcare facilities and to protect the individuals from harm(National safety and quality health service standards, 2012). In addition, the healthcare staffs are responsible for improving the safety and quality of the services and patient catered care facilities(Sarı, Baysal, Celik&Eşer, 2018). The NSQHS assure that the proper monitoring system can increase patient safety. The medical professionals are supported to deliver comprehensive care and manage the risk (NSQHS, 2019). In our case study, the treatment process of Fred is safe and justified with the situation. The healthcare professionals are working together torecognising any deterioration of his physical condition. Therefore, clinical governance will provide better care andservices for him.