Introduction
The nursing profession comes with a number of expectations on the part of the nurse. Nurses are expected to balance several factors to ensure that all stakeholders within are fully satisfied. Among the expectations from the nurse is ethical handling of the patients, handling the patient in accordance with his or her wish among other issues that cuts across the ethical, legal and social realms of life.
This paper examines the case of Mr. Frank, a 68 year old post-operative patient who on his first day of post operation care in the ward becomes disoriented, excessively abusive and whatever surface available with excrement oozing from his wound. The paper will specifically be focused in deciphering the ethical responsibilities of a nurse faced with the care of Mr. Frank who has refused to be attended to. There shall be several ethical theories such as deontology and utilitarianism as well as several ethical principles that will be used to analyze the case.
Main Body (Analysis and Synthesis)
Mr. Frank’s case can result to an ethical limbo to any nurse, whether experienced or not. As noted by Morris and Faulk, (2012), nurses should be cautious while handling patients and should ensure that patients’ demands are met. They are expected to ensure that patients are helped to heal as fast as it can be practically possible through adequate attention and medical care provision (Hope et al, 2008). However, Frank’s case presents a different scenario that demands that any responsible authority must invoke several ethical considerations in decision making.
While making the decision in this case, the main issue of focus should be the general safety of Mr. Frank as well as the safety and comfort of other patients in the ward. This means that a nurse can invoke the utilitarian theory that advocates for actions that yield the greatest good to the greatest number of people (Morris and Faulk, 2012). Although it is advisable that a patient’s wishes should be given considerations, Mr. Frank is not in a sound mental position to make informed choices concerning his health. Thus, his actions are against his own good which means that a responsible nurse should use all the available resources to ensure that the patient is managed effectively. This means that the patient’s assertions of not wanting to have a bath must be ignored as his post-operation wound can be contaminated leading to further complications. Therefore, it would bring more benefit to the patient if his wishes were ignored than if they were followed.
The patient’s wishes can be ignored based on the argument that his conduct causes harm to the majority (Fremgen, 2010). The act of soiling the bed and any other surface ruins a favourable environment for other patients which means that should attention be accorded to utilitarian theory, the patient needs to be contained for the sake of the other patients. As a nurse, there is need to come up with a strategy that would ensure that Mr. Frank is attended to, cleaned and further precautions taken to ensure that he is no longer a source of harm.
The case can also be analyzed from the deontological point of view. According to Morris and Faulk, (2012), deontology ethics is defined based on the obligations and duties that a specific party must take for the benefit of a subject. Going by this definition, the nurse is bound by professional ethics to ensure that the case of Mr. Frank is handled for the patient’s benefit. This means that the nurse must come up with measures that would ensure that the patient’s condition is managed effectively. The nurse has a duty to initiate the procedure that should eventually yield to the possible causes of the disorientation. Since this may be outside the nurse’s sphere, there is a need for the nurse to involve other relevant stakeholders such as anesthetists and doctors to ensure that the origin of the disorientation is established. For instance, there is a need to establish whether drugs such as methylene blue that has been cited by Siebert, Kroeber and Lutter, (2005), as a cause for many postoperative disorientation was used. This way, the patient can be helped to ensure that his abdominal post-operative wound is protected from self-inflicted injuries. Besides, if the patient’s mental disorientation is proved to have originated from the nature of drugs administered, the case can help future treatments in the process of determining the required drugs. Besides this, Mr. Frank’s case can assist anesthetists to come up with a better combination of drugs to minimize post-operative mental disorientation cases (Barash, Cullen & Stoelting, 2006).
As far as ethical principles are concerned, the case can be examined from several ethical principles. When arguing on the basis of autonomy, it is important to put into considerations the assertions raised by Rotarescu and Ciurea, (2012), that the principle has many prima facie implications. Patient’s autonomy should be respected and thus there is need to obtain an informed consent before deciding the actions to be taken. This means that Frank has already refused to consent for the cleaning attention that the nurse is interested in giving which means that if the principle of autonomy was to be followed, then the patient should be left alone. However, it is important to note that the principle of autonomy is based on the principle of informed consent which the patient is not in a position to offer due to his mental disorientation. Therefore, the nurse can take actions that are in the best interest of the patient as opposed to the patient’s consent.
It is important to ensure that all actions aimed at helping Mr. Frank are free from harm. It is also important to conduct a cost-benefit analysis on the feasible decision to ensure that actions that are for the benefit of the patient are taken (Morris and Faulk, 2012). This is the principle of beneficence. Similarly, all actions by the nurse must be to protect further harm as opposed to doing harm as per the principle of non-maleficence. Finally, the entire decision making process in the case of Mr. Frank must be guided by the justice principle. The principle which calls for fairness when one is faced with competing decisions should assist the nurse to make a decision that is aimed at helping the patient.
Apart from the ethical considerations highlighted above, there are also some legal principles that can inform the decision to be taken in this case. To begin with, there is an implied responsibility of the health care providers to take care of the patient together with all the health developments that may affect his condition bearing in mind that states of mental instability after anesthesia are well documented (Lubin & Smith, 2006). This means that all the health care providers tasked with the responsibility of taking care of the patient are bound by law to ensure that he is well taken care of (Lloyd, Ma & Vizcaychipi, 2012). There is an implied obligation that where the patient cannot make an informed judgment, the responsible authorities will make this judgment for the patient. Secondly, there is the issue of decision made by a PUM (Person of Unsound Mind). Since Mr. Frank’s state of mind qualifies to be unsound, obeying his wishes can be passed as an act of negligence and thus can be challenged in a court of law. Therefore, the responsible nurse must ensure that this loophole is sealed by not following what the patient’s wishes. Finally, there is the issue of negligence. Obeying Mr. Frank’s wishes will amount to negligence and failure to adhere to implied responsibility of a nurse or health care provider and thus punishable before a competent court of law.
Thus, it should be the decision of the nurse to ensure that Mr. Frank’s condition is managed as there is an implied responsibility on the part of the nurse to protect Frank’s life. Besides this, accepting Frank’s wish not to be attended to can be argued to be an act of negligence on the part of the nurse as Frank is a PUM and thus cannot enter into a valid contract that can be enforceable in a competent court of law (Fremgen, 2010).
Conclusion
In conclusion, although it is true that health care providers must respect the autonomy of their patients, there are areas where this respect can be violated. Health care providers must be focused to deliver the best option to their patients. Where conflicting ideologies exists, there is need to invoke various ethical principles and actions that yield the greatest benefit against the least harm being adopted. In the case of Frank, nurses and other care givers can ignore his wishes as his mental condition affects his judgmental skills and thus may not be able to make any informed decision. Besides, leaving a PUM to make decisions regarding his health can be qualified as an act of negligence.
References
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