PUBH6008 Nursing Case Study Analysis On Moral Dilemma Assessment 3 Answer

Answer :

NURSING REPORT

Abstract 

In the present scenario, nurses face a substantial ethical dilemma in identifying best strategy to treat a patient. This report is intended to show a nursing case study analysis that mentions a moral dilemma. The case study has indicated that Jade is one of the newly graduated RN who has been assigned to offer care to critically ill patient Bethany. The case has also mentioned that Bethany's mother does not want to give medicines to her daughter so that the doctors have decided to take custody of Bethany. In that consequence, Jade has faced an ethical dilemma and told the doctor's plan to Bethany's mother.  The report shows a brief overview of the nursing standards that nurses need to follow to offer a better service to the patients. A good overview of a newly graduated nurse's roles and responsibilities is also shown in the report.

Introductions:

Nursing is one of the intensely-personal occupations. Nurses develop engagement with the patients in their life’s vulnerable time. During offering life-saving services to the patient, nurses have to consider different ethical and legal considerations. There are vast numbers of scenario when nurses face some dilemma in providing services to their patients. This report is intended to perform a case analysis where the roles and responsibilities of registered nurses have been clearly shown. Moreover, some ethical dilemmas have also demonstrated in the case study.

Outlining the specific events of the scenario: 

The case study has clearly shown the fact that Bethany is one of the 11-year-old girls who are suffering from Acute Lymphocytic Leukaemia. Presently, Bethany has developed infections in her chest. However, nurses and doctors are facing issues in offering any treatments to Bethany because of her mother. The mother of Bethany is one of the religious people who believe that it is not right to provide any medicines to patients. For the chest infection, Bethany strongly needs antibiotics because her fever was increasing. This situation has created an ethical dilemma for nurses. This is because, an RN need to offer excellent services to the patients, but due to the protest of a family member of the patients, RN cannot provide proper treatments to the patients.

After facing this issue, the nurses, as well as doctors, have decided to take legal action against the mother of Bethany so that they can get the custody of Bethany to start the treatment process for her. After hearing the plan of them, the newly graduated RN has discussed the fact with the mother of Bethany. As a result, the mother of Bethany has taken Bethany home so that no one can provide medicines to Bethany. Due to the activity of Jade, other nurses have got angry with Jade. By considering the nursing standard 1 for the professional RN, it can be said that it is the duty of Jade in facilitating critical thinking and analysing the nursing practice for offering better services to Bethany. Jade should use the best possible evidence in providing quality and safe person-centred services to Bethany. However, Jade has used the potential resources for understanding the actual health condition of Bethany, but she did not develop any plan or strategy in offering services to the Bethany. 

It is ethical for Jade in informing the family of the Bethany about the health condition of Bethany and possible treatment process available to treat Bethany. Jade performed her task well, but she has missed the ethics to save a patient at any costs. Jade should be agreed to doctors, and the nurses for taking the custody of Bethany as Bethany's mother is restricting the treatment of her due to some religious beliefs. However, Jade is a newly graduated RN so that she has faced difficulties in resolving this ethical dilemma. In this situation, Jade has become confused and inform the mother of Bethany about the plan of other doctors and the nurses. From the perspectives, it can be said that Jade is unsuccessful in applying clinical decision making to treat her patient Bethany. According to Ten Cate et al. (2016), clinical decision making refers to the process by which medical practitioners determine who needs when and what. From the case study, it can be said that Jade has only considered her ethics but not the health of the patients. As a care worker, Jade should consider the health of Bethany and help other professionals to treat Bethany. However, she tells everything to the guardian of the patient who is unwilling to treat the patients.

The ethics of nurses always discuss the moral reasoning for determining what appropriate or inappropriate situation is (Kangasniemi, Pakkanen & Korhonen, 2015). It is necessary for the well being of the individuals. However, Jade has become failed to identify the appropriate moral reasoning, where she has completely ignore the well-being of Bethany and only considers the autonomy and the rights of the patients. This activity of Jade can create a legal issue, and she can be suspected of negligence because the actions of Jade can create permanent damage to Bethany. This is because, indirectly, Jade has helped the mother of Bethany to kill her daughter. In every healthcare organisation, teamwork is one of the primary requirements where every professional need to work with each other and share information to offer better services to the patients (Dehghani, Mosalanejad & Dehghan-Nayeri, 2015). From the case study, it is also clear that Jade has ignored the teamwork. She has heard the plan from other nurses to save Bethany and tell it to the mother. Therefore, it can be said that Jade has disobeyed the teamwork in her workplace and developed an interdisciplinary practise issue. 

Relevant policy documentation for supporting decision:

For supporting the issues mentioned above in the case study, the code and guideline documentation by the nursing and midwifery board of Australia can be considered. NMBA guideline has published some standards that need to be followed by the nurse in offering extensive services to the patients.  The standard 1 of NMBA guideline described that registered nurses must utilise the different strategy of thinking to make decisions (to provide better services) from various evidence (Nagle & Vogt, 2018). Therefore, for offering services to Bethany, Jade should develop practices with the help of the reflection on the knowledge, feelings, actions and beliefs. However, due to inefficiencies in experiences, Jade has become unsuccessful in applying the best possible strategy to save Bethany. Standard 2 demonstrated the fact that every RN must be engaged in the professional as well as therapeutic relationships with the patients (Nagle et al. 2017). In that context, Jade has developed an excellent personal relationship with the patient Bethany and her mother, but she has disrespect her professional value. 

Standard 3 has mentioned the fact that every RN needs to be ensured that they are capable of performing practice and becoming safe (Fisher, 2017). This standard said that RN is responsible for the professional development of them, and they are also responsible for facilitating the professional development of others. However, in her second week of the working, Jade has disclosed confidential professional information to the families of patients. From this point of view, it can be said that Jade has breached this standard. This is because, by disclosing the information, Jade has created a difficult situation in her professional development. The standard 4 of the NMBA describes that RN must accurately assess the health condition of the patient (Edmonds, Cashin & Heartfield, 2016). After analysing the information, an RN needs to communicate the outcome with other RN or doctors so that together they can offer a better service to the patients. By applying the standard on the case, it is clear that for providing an excellent service to Bethany, Jade need to collect sufficient information about the health condition of Bethany. For this purpose, Jade should be present in the hospital at the right time, but she became late. After gathering information about the health condition from the written notes of the nurses of previous shifts, Jade has visited Bethany. As Jade become unsuccessful to analyse every possible information about Bethany, so she has faced an ethical dilemma. She has informed Bethany’s mother that doctors are planning to take the custody of Bethany that has made Bethany’s mother to release her daughter from the hospital so that anyone cannot provide medicines to her.

Standard 5 of the NMBA demonstrated that nurses must develop a plan to offer better services to the patients (Edmonds, Cashin & Heartfield, 2016). In that context, Jade has become unsuccessful in developing a plan to create a good treatment process for patients. Jade has not developed a plan to treat Bethany, and when doctors told her to offer medicines to Bethany by applying some tricks, then she has denied offering medicines. Jade has become unsuccessful in providing appropriate, safe along with responsive nursing practices that made her breached standard 6. The case has revealed that Jade does not have a focus to evaluate the outcome of her nursing practices so that it is clear that Jade has breached standard 7.

Key roles and responsibilities of a newly graduated RN:

Professional development is one of the processes that starts during undergraduate education and continues throughout the work-life (Regan et al. 2017). The transition of a nurse from new to experiences is difficult. For becoming a good nurse, it is essential for a new nurse in following the instruction of the experienced nurses at the initial stage so that a better overview of caregiving can be gained. Therefore, it can be said that a new registered nurse must understand the process of treatment and gain better knowledge about the clinical decision making from the experienced nurse to treat a patient with betterment.  

The primary role and responsibility of a new registered nurse are displaying awareness about taking proper care of patients, becoming communicators, coordinator and decision-makers. Therefore, as a new registered nurse, Jade must offer better treatment to Bethany, communicate the family members of Bethany to make them agreed to apply the medicines and maintain collaboration with the other RN and doctors. Along with that, Jade need to communicate the other RN to identify the exact health condition of patients because she is new, and she does not have good knowledge about the condition of patients. Moreover, Jade should communicate with other RN to develop a proper decision to offer better care to the patients.

A new RN needs to develop a leadership role in ensuring the safety of patients and offering high-quality care services to the patients (Murray‐Parahi et al. 2016). As a leader, a new RN must coordinate with the healthcare teams, families of the patients, along with patients to create the positive health-related outcome of the patients. Therefore, Jade need to coordinate Bethany, her mother and the nurses and doctors for offering good services to Bethany for improving her health conditions. For developing and maintaining cooperation among the care team, Jade must apply a better leadership style. Application of the participative leadership strategy is always necessary for care setting because every professional are skilled to offer clinical services to the patients. Therefore, receiving ideas from them to treat a patient would be better.

Moreover, newly qualified staffs are associated with continuously communicating the family of patients and patients for assessing their emotional, physical as well as psychological needs (Laschinger & Read, 2016). Therefore, as one of the new RN, Jade need to continuously communicate Bethany and her mother so that treatment can be initiated for Bethany. In that context, as an RN, Jade must form a personal relationship with the patients so that it can help her to assess the health condition of Bethany. A new RN is also involved in conducting good research for understanding the evidence-based practice in an organisation (Arrowsmith et al. 2016). As Jade is one of the new RN, therefore, she has a lesser capacity to facilitate evidence-based practice along with clinical decision making. Thus, the conduction of proper research can help Jade in securing better performance.

Additionally, Jade need to identify the outcome of the treatment so that it can assure her about the achievement of treatment-related goals. As an RN, Jade need to monitor the patients for understanding the efficiencies of treatment conducted by her. A new RN is involved in strengthening some coping strategies, improving accesses of different resources of a community, improving functions, developing as well as managing plan and maximising the independence in the organisation (Pasila, Elo & Kääriäinen, 2017). Moreover, as a newly hired RN, Jade need to learn to handle the ethical dilemma so that she can take proper decision to treat her patients. Along with that, as an RN, Jade should offer safer and quality nursing services to the patients. The other role that needs to be played by Jade is to learn the practical application of the nursing standard of NMBA. 

Making recommendations in the situations:

The issues have happened because Jade did not follow the nursing instruction by the NMBA. Jade has correctly followed the nursing ethics to inform patients and their family about the treatment process, but when the patient party is restricting the process of treatment, then Jade has inform them the entire plan of the doctor to treat the patient. However, Jade does not inform them of the process of treatment as she has not developed any plan for the treatment. Jade has told them the plan to take Bethany's custody, which she must not inform patients and family. Though the nursing standard describes that it is necessary for developing a personal relationship with the patients but for developing a good relationship, a nurse should not disclose every plan of the care team. From the role of RN, it can be said that a new RN needs to maintain collaboration with the care team to offer better treatment. It is seen from the case that Jade has not followed this role.

There are different ethics that nurses need to follow during offering care to the patients, but throughout the nursing career, nurse faces an ethical dilemma. Therefore, Jade should learn how she could handle this ethical dilemma and offer proper care. Moreover, Jade must learn the practical implications of the nursing standards. 

The modern healthcare industry has been developed based on the multidisciplinary approach related to the care of patients. The nurse should work closely with another nurse as well as specialists and the physicians for offering excellent care. For this reason, development of teamwork is essential to maintain better communication and achievement of the efficient patient-related outcome. The case study has mentioned that all the issues have happened because Jade was not interested in teamwork to offer treatment to Bethany. Therefore, for resolving this situation, Jade should learn how to develop and maintain teamwork to provide better care to the patients. Teamwork is always essential in improving patient outcome and satisfaction. Teamwork can help new RN like Jade to enhance accountability in the profession and achieve job satisfaction. Teamwork can help Jade in forming a better engagement in the workplace.

Jade must be more responsible for her workplace. The case study has established the fact that Jade always becomes late in her workplace. For this reason, Jade still miss the conversation with other RN from the previous shift that creates difficulties for her in identifying the exact condition of patients. For resolving the issue, Jade should be more responsible for her job. 

Conclusions:

The above description can conclude that for offering proper care to patients, a nurse must develop their clinical decision-making capabilities. The nurse must learn how to solve ethical dilemmas for providing adequate care to the patients. The above discussion has also concluded that better teamwork is always essential in every care setting. This is because it helps in identifying the exact condition of patients so that proper care can be offered to them as per the requirements.