In simulation game, two dilemmas were presented. The first case is happened to a 16-year-old mother, RB. She is in her tenth hour of labor. Her parents are at bedside with her. Because of religious belief, they have chosen to limit the amount of medication and other medical assistance. Due to the length of her labor, her unborn child’s situation is getting worse. RB has not received any medication so far. Because of her fear and distress, fetal distress has been increasing gradually. RB’s brother stated that their parents want the staff hold the painkiller and treatment because they punish her for getting pregnant before she was married. RB is still a minor, her parents are informed of her health status, but we are not sure whether or not they understand how dangerous her situation could get. In the second case, one of the ICU patient, AT, was brought to the hospital by his domestic partner, YM. YM was accompanied with him while both of them were in the ER, but he was not allowed to visit his partner in the ICU.
The shift supervisor nurse stated she would follow the rules and allow actual family members visit the patient. AT has been unconscious for one day and no definitive diagnosis has been reached. He was in critical condition and cannot make decision by himself. There is no related information on patient’s file whether or not approve or refuse the current treatment. In order to address ethically, I need to be attentive. So I have to identify the real dilemma first. In the first case, the teen and her unborn child need medical care but her parents are the legal guardian that have legal responsibility for her care. Now I have already now the problem, the next step is to be intelligent. I need to use my critical thinking skill to evaluate the facts. Also, I need to think about my obligation to my patient and how my decision affects each person involved in this case. Hence, the decision needs to be fair, fulfill my duty, and reasonable. I have to assure that the patient and her unborn child get appropriate medical care, her parents’ wishes are being honored, and I will follow hospital’s policies and rules.
After careful consideration, my decision is to ask the assigned nurse to call a physician to make sure the mother and baby are assessed medically, they will get appropriate and necessary care, and both of them will be safe. Meanwhile, I will contact the chaplain to make sure patient’s parents’ values are respected by the medical care team. In the second case, I have to identify patient’s domestic partner’s rights and each person’s emotional state. Then I have to consider how to perform my job duty responsibly and my obligations to the patient, and patient’s best interest. The issue they have now is how to assure access for same-sex partner’s patients on equal footing with heterosexual couples. Because the same-sex partner do have some rights in this situation such as right to make decision for an unconscious family member. Since my patient, AT, is still unconscious and he can’t make any decisions for himself. So, my decision is to give YM access to his loved one and treats him as family. I will also speak to my supervisor about my decision. When utilizing ethical lenses, it will guide me make a sound decision.
In the first case, I used right/responsibilities lens and results lens. The right/responsibilities lens focuses on duties and obligations, and be ethically acceptable. The results lens focuses on the duties and what meets individual desires, which means I have to consider how my action will affect each person. Hence, I have to combine all the analysis and my knowledge to make a sound decision in order to satisfy each person’s ethical desires. The second case, I used relationship lens and reputation lens. The relationship lens focuses on being fair. In order to be fair, I have to use my power appropriately and everyone’s rights as a person. For instance, I need to know the patient’s domestic partner’s rights and what kind access I can give to him. The reputation lens guides me focus on the virtues of each person. The rights/responsibilities lens allow me to consider my duty as a nurse and how to accomplish my duty. My patient and her baby’s safety are my top priority.
Hence, I have to call the physician and notify him that my patient needs medical care. When using the results lens, I need to consider how to create a satisfied result to meet my patient and her family member’s needs and honor patient’s parents’ wishes as well. Hence, I have to contact the chaplain to comfort patient’s parents in order to meet their spiritual needs. The relationship lens allow me to consider my patient and his domestic partner’s rights. Hence, before I make a decision. I look at hospital’s policy and rules. I want to make sure I give my patient’s partner his rights to access his loved one while I am still implementing hospital protocols.
The reputation lens leads me to think about how to be a good nurse and how to provide best care for my patient. Also, I have to let my supervisor understand my decision and my standard as an employee and a nurse. As a home health nurse, we meet patients who from countries and who has different beliefs, and cultural backgrounds. I think when I have an ethical conflict, I have to assess the situation and gather data instead of making assumptions. After I collect data, I need to think about how the decision will impact each person involved in this case (right/responsibilities lens). As a nurse, I also need to remember ANA Code of Ethics. I have to remind myself I need to
EthicsGame.com, LLC. (2007). The troubled teen and policies an politics. Retrieved from: http://www.ethicsgame.com
Guido, G. W. (2010). Legal & ethical issues in nursing (5th ed.). Upper Saddle River, NJ: Prentice Hall.