Nursing Case Study Of Aggressive Prostate Cancer Patient - Samples

Question: Discuss about the Nursing Case Study of Aggressive Prostate Cancer Patient. Answer: Introduction: The nursing profession entails caring for individuals, their family and even communities in order to achieve, maintain or recover mental and physical well being and quality of life. It also includes promoting well being, preventing illness, and caring for the ill, disabled or dying individuals (who.int, 2018). Nursing philosophy therefore is based on several ethical axioms that ensure respect to human rights (icn.ch, 2018). The ethical codes include: beneficence, non-malfeasance, fidelity, autonomy, justice and integrity (Shahriari, Bahrami, Abbaszadeh Bahrami, 2018). Several dilemmas are caused while trying to maintain the ethical code of conduct in nursing, and can include issues related to informed consent, disclosure of medical conditions and incompetence among peers (Cherry Jacob, 2016; Zahedi et al., 2013). Jie (2015) pointed out that nowadays, nurses face an increased number of situations of moral dilemma, and this is especially while caring for terminal patients. Gibbs Model: Description of scenario The patient Mr X (name withheld to protect patients privacy) is a 60 year old gentleman suffering from aggressive prostate cancer, and was being treated in the oncology department of a general hospital in Malaysia. The diagnosis was done 5 years ago, however the patient chose to opt for alternative treatment, and refused medical or surgical intervention. The patient also did not follow up with any urologist over the last five years and currently the patient has been diagnosed of anaemia and hypoproteinemia. Subsequent diagnostics showed the local spread of the cancer to the lymph nodes and metastasis to the bones, while the primary tumour invaded the bladder, partially blocking the left kidney. Over the last 3 months, Mr X was admitted repeatedly to the hospital, that last admission was after a cystectomy that showed more extensive growth of the tumour, after which further surgical and medical treatment was deemed inappropriate, and the patient was recommended palliative care. After this, the patient resigned to the fact that he was about to die, and confided in me about his wish to kill himself, and stop his suffering, and requested me not to divulge this to anyone else. However, upon serious consideration of the request, and its consequences, I had to report this incident to my supervisors, after which intervention was planned for the patient, to help him overcome his emotional trauma. He was provided palliative care, and stopped showing any signs of suicide attempt. He passed away peacefully after 2 days of being discharged, in the midst of his family and friends. Feelings in the scenario: This was a difficult situation for me, since fulfilling the patients wish and being silent of his plan to end his own life had a serious ethical conundrum. As per Beauchamp Walters (1982), ethical dilemma is a situation where an individual has to choose between mutually exclusive alternatives, while Chally Loriz (1998) suggested that ethical dilemmas occurs while choosing between two or more, morally correct but mutually exclusive issues. In the scenario described above, my moral dilemma was due to conflicting moral principles. One that dictates respect for beneficence and autonomy of patients decisions, and other that emphasizes on non beneficence, fidelity and integrity. Respecting the wish of the patient not to divulge his plan of suicide would be in agreement to the principles of autonomy (respecting patients wishes) and beneficence (as the patient feels his suffering can be stopped only with his death). However, doing so will also jeopardize the principles of Non-Malfeasance (ensuring no ham is done to the patient, either intentionally or unintentionally), fidelity (maintaining the virtue of caring) and integrity (ensuring ethical practice is maintained in nursing care). Also, divulging the wish of the patient can have judiciary implications, as it can lead to discrimination of the patient, and breach his trust and confidentiality (Kelley et al., 2015; Saunders, 2017). Evaluation of the experience: Ethical dilemmas can be caused due to logical incompatibility between two opposing principles, especially in moral situations, where two different principles are applicable, but following one principle can cause violation of the other. Effectively, regardless of the choice, one moral principle will be violated (Ganz, Wagner Toren, 2015; Christensen et al., 2014). This justified the evaluation and prioritization of the conflicting principles, trying to understand which principle should take precedence over other, and following that. The preference will be given as per action that can have most benefit and least harm for the patient. Since obeying the patients wishes would have resulted in the patient attempting suicide, and thus risking his life, while not doing so would mean breach of trust, confidentiality as well as show disrespect to patient autonomy, but would not cause loss of life, I decided to respect the principle of non malefiscence. Furthermore, it also was in accordance w ith my principles of integrity of ensuring care being provided to the patient, and reports any situation that can lead to the harm of the patient. Analysis of the situation: A good action is one that can minimise suffering and maximise well being. This axiom is a part of the utilitarian principle, and is fundamental to ethics, and dictates that morally correct action should have the best outcome for the most number of people (de Lazari-Rad Singer, 2017; Felzmann, 2017). In my scenario, choosing to report the incident to the authorities would not only prevent the patient from harming himself, but also protect the concerns of the patients family and also prevent jeopardy to the healthcare staff (in the event of patient committing suicide in the hospital premise). This can be justified by the consideration on how suicide can have negative impact on family and healthcare staff, and can cause a sense of guilt, shame or upset (Peters et al., 2016; Pitman et al., 2014). Therefore my analysis considered it morally wrong to keep the patients intent a secret. Conclusion: Incidents of patients attempting to harm themselves or end their lives are becoming increasingly common in nursing practice (Jie, 2015). This necessitates critical analysis of the ethical dilemmas posed by such situations. Since nurses have an ethical and moral responsibility of providing care for the sick, disabled and elderly, any moral and ethical challenges to the providence of proper care should be studied. Action Plan: The action plan that I followed in this scenario was to repost the incident to my supervisors, which allowed the prompt implementation of an intervention to help the patient. The effectiveness of the intervention was exhibited by the patient finally deciding not to attempt suicide, and was subsequently discharged. References: Beauchamp, T. L., Walters, L. (1982). Contemporary issues in bioethics. Chally, P. S., Loriz, L. (1998). Ethics in the trenches: Decision making in practice.AJN The American Journal of Nursing,98(6), 17-20. Cherry, B., Jacob, S. R. (2016).Contemporary nursing: Issues, trends, management. Elsevier Health Sciences. Christensen, J. F., Flexas, A., Calabrese, M., Gut, N. K., Gomila, A. (2014). Moral judgment reloaded: a moral dilemma validation study.Frontiers in psychology,5, 607. de Lazari-Radek, K., Singer, P. (2017).Utilitarianism: A Very Short Introduction. Oxford University Press. Felzmann, H. (2017). Utilitarianism as an Approach to Ethical Decision Making in Health Care. InKey Concepts and Issues in Nursing Ethics(pp. 29-41). Springer, Cham. Ganz, F. D., Wagner, N., Toren, O. (2015). Nurse middle manager ethical dilemmas and moral distress.Nursing ethics,22(1), 43-51. icn.ch. (2018).Code of Ethics for Nurses.Icn.ch. Retrieved 6 February 2018, from https://www.icn.ch/who-we-are/code-of-ethics-for-nurses/ Jie, L. (2015). The patient suicide attempt An ethical dilemma case study.International Journal Of Nursing Sciences,2(4), 408-413. https://dx.doi.org/10.1016/j.ijnss.2015.01.013 Kelley, M., James, C., Alessi Kraft, S., Korngiebel, D., Wijangco, I., Rosenthal, E., ... Lee, S. S. J. (2015). Patient perspectives on the learning health system: The importance of trust and shared decision making.The American Journal of Bioethics,15(9), 4-17. Peters, K., Cunningham, C., Murphy, G., Jackson, D. (2016). Helpful and unhelpful responses after suicide: Experiences of bereaved family members.International journal of mental health nursing,25(5), 418-425. Pitman, A., Osborn, D., King, M., Erlangsen, A. (2014). Effects of suicide bereavement on mental health and suicide risk.The Lancet Psychiatry,1(1), 86-94. Saunders, B. (2017). First, do no harm: Generalized procreative non?maleficence.Bioethics,31(7), 552-558. Shahriari, M., Bahrami, E., Abbaszadeh, A., Bahrami, M. (2018).Nursing ethical values and definitions: A literature review.PubMed Central (PMC). Retrieved 6 February 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748548/ who.int. (2018).Nursing.World Health Organization. Retrieved 6 February 2018, from https://www.who.int/topics/nursing/en/ Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A. et al. (2013).The Code of Ethics for Nurses.PubMed Central (PMC). Retrieved 6 February 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712593/