Introduction
Leah Curtin’s Classic Model model has seven steps that guide the decision making process. It should be noted, however that the model should not be followed too strictly to blind other important considerations in decision making. In this model, the order of the steps is flexible and can be altered, so long as all the first six are considered before step seven.
Steps
Put together all information about the conflict in question in order to get a background of the information. This information can be classified into medical, personal and economic.
Medical risk will help in weighing the dangers and benefits associated with the particular case. Personal information helps in decision making while considering family values and beliefs. The cost and benefit analysis is guided by the economic information.
Verify the issue at hand by checking who are involved in the conflict and if the conflict touches on the nurses’ roles and ethical values.
Identify all the stakeholders in the ethical dilemma. Usually, these stakeholders are the patient’s family, health care provider and sometimes the government. It is also important to establish who the prime decision maker is; for instance, a doctor would be the best person to decide what kind of treatment would be best for a patient while it is the patient’s right to decide whether they want to be treated at all.
Have a number of possible solutions and their repercussions. This list is important because it helps you consider many possible outcomes. It is vital that as many possible solutions as possible be considered because this enhances the chances of making a good decision. The potential consequences of the alternatives should also be considered.
Use the available ethical theories and principles. In this step, ethical theories and practice principles are applied to the possible solutions. The solutions are evaluated and tested for conflict with ethical practice values and/or theories. The alternatives that are seen to clearly contradict practice principles and ethics can be dropped first. After those are dropped, then the others can be ranked logically to ensure the best end result.
Select the most suitable alternative. In this step, a decision is made after careful consideration. The decision must be made based on a clear and defendable rationale.
Act. In this step, the decision maker then goes ahead to act upon the decision made and implement the right thing
Application to the case
The information we have is that Mrs. Z had a biopsy and the results are positive, Mr. Z has started seeing higher medical bills and Mrs. Z does not want to share her biopsy results with her family.
The issue at hand is that Mrs. Z does not want to reveal her medical results to her family. Mr. Z is concerned about his wife and is also hurting economically because he has to pay medical bills that he doesn’t understand. Dr. F cant reveal the biopsy results to Mr. Z because of patient confidentiality/.
The stakeholders are: Mr. Z, Mrs. Z, their family, the nurse, Dr. F and Dr. J.
Alternative solutions would be
- For Dr. F to keep the information from Mrs. Z’s family and maintain confidentiality
- For Dr. F to break confidentiality and tell the family for the sake of Mrs. Z’s health
- For Dr. F to drop the patient and never call her again.
Option ‘III’ is clearly in violation of the law and practice principles and is dropped first.
Options ‘I’ and ‘II’ are then considered using the ethical theories. In this case, the utilitarianism theory is applied and option ‘II’ is ranked first.
Dr. F therefore reveals to Mrs. Z’s family her biopsy results so that they can ensure she gets the best health care possible.
Nursing Interventions
There are many instances in which there will be ethical conflict. It is therefore important for nurses to have some means of intervention to reduce these conflicts.
One of the ways in which nurses can reduce this is by consultation. As in the case, the nurse can consult with fellow nurses and/or doctors to get different opinions and then make a decision.
The nurses can also use a multifaceted approach in handling their decisions. This, they can do by using the prescribed decision making models , consulting widely when faced with ethical dilemmas and applying personal intuition all at the same time.
Another way that I feel nurses can use to help reduce conflicts is by use of research and learning. Research is important because it can help nurses read about case studies done before, the ethical dilemmas faced, the decisions made and the outcomes. The nurses can then use this information to relate to their day to day cases and help them make more informed decisions.
Lastly, the nurses can use effective communication to let the patients know the risks and benefits of any medical decisions they make.