Ethical Considerations and Strategies for Supporting Patient and Family in End-of-Life Decision Making
Mr. Rodriquez, a 78-year-old man who recently immigrated to the United States, was admitted to the medical unit, and diagnosed with acute lymphocytic leukemia. The hematologist caring for this patient has explained reasonable treatment options for an individual of Mr. Rodriquez’s age and general medical condition. His daughter, who is distraught and unable to comprehend everything happening, tearfully asks the staff nurse, “If it were your father, what would you do?” The staff nurse repeats much of what the physician has said, attempting to clarify whether the daughter understood the recommended treatment and palliative care measures.
Although her father appears to accept these interventions, the daughter continues questioning the nurse, repeatedly asking the nurse what she would do if it were her father. She tells the nurse that she does not want her father to suffer, but she also wants her father to live as long as possible. She has also used the Internet to learn more about possible treatment options and has questioned many of the staff nurses on the unit about whether they would insist that more be done to preserve the life of a loved one.
The staff nurses have now come to you, the nurse manager, for advice on working with this patient and family.
1) Determine which ethical principle or principles are the most appropriate to consider in this instance and which principle or principles would best assist in guiding staff members.
2) What role, if any, does health literacy play in this scenario?
3) Are there additional resources within the facility that you might ask to assist in helping the staff care for this patient and family?
4) How might you begin to ensure that the staff nurses can better deal with such issues in the future?
Title: Ethical Considerations and Strategies for Supporting Patient and Family in End-of-Life Decision Making
Introduction:
In the given scenario, the staff nurses are faced with a complex situation involving Mr. Rodriquez, a patient diagnosed with acute lymphocytic leukemia, and his daughter who is struggling to understand and make decisions regarding his treatment. This essay will address the ethical principles that should guide the staff nurses in this instance, the role of health literacy in the scenario, potential resources within the facility to assist the staff, and strategies to empower nurses in dealing with similar issues.
Ethical Principles:
The most appropriate ethical principles to consider in this scenario are autonomy, beneficence, and non-maleficence. Autonomy refers to respecting the patient's right to make decisions about their own healthcare. In this case, Mr. Rodriquez's daughter wants to be involved in decision making and seeks guidance from healthcare professionals. Beneficence involves promoting the well-being of the patient, which includes providing appropriate treatment options and palliative care measures. Non-maleficence emphasizes the obligation to do no harm, ensuring that the proposed interventions do not cause unnecessary suffering or adverse effects.
These ethical principles should guide the staff members in fostering open communication, actively involving the patient and family in decision making, and considering both the desired quality of life and potential risks of treatment options.
Role of Health Literacy:
Health literacy plays a crucial role in this scenario as Mr. Rodriquez's daughter has been seeking information online and asking multiple nurses about treatment options. Health literacy refers to an individual's ability to obtain, process, and understand health information to make informed decisions. In this case, it is important for the staff nurses to assess the daughter's health literacy level and provide accurate, clear, and unbiased information to facilitate her understanding and decision making.
Additional Resources within the Facility:
To support the staff in caring for this patient and family, there are several resources within the facility that can be utilized. Firstly, a clinical ethicist or ethics committee can be consulted to provide guidance on complex ethical dilemmas. They can assist in facilitating discussions among the healthcare team, patient, and family to ensure all perspectives are considered and respected.
Secondly, social workers or patient advocates can help address emotional and psychosocial concerns of both Mr. Rodriquez and his daughter. They can provide counseling, support groups, or referrals to community resources that can help alleviate their distress and enhance their coping abilities.
Finally, palliative care specialists can offer expertise in managing symptoms, improving quality of life, and facilitating discussions around end-of-life care. They can collaborate with the healthcare team to ensure that Mr. Rodriquez's goals and preferences are respected throughout his treatment journey.
Strategies for Future Preparedness:
To better equip staff nurses in dealing with similar issues in the future, it is essential to invest in ongoing education and training. This can include workshops or seminars on ethical decision making, effective communication strategies, and cultural competence. Role-playing exercises can also be incorporated to simulate challenging scenarios and enable nurses to practice their skills in a safe environment.
Furthermore, establishing regular debriefing sessions or case reviews can provide an opportunity for staff nurses to reflect on their experiences, share insights, and learn from one another. Encouraging an open and supportive team culture will foster a safe space for discussing ethical dilemmas and seeking guidance from experienced colleagues or ethicists.
Conclusion:
In conclusion, addressing ethical principles such as autonomy, beneficence, and non-maleficence is crucial when dealing with complex end-of-life decisions. Health literacy plays a significant role in empowering patients and families to make informed choices. Utilizing available resources within the facility, such as clinical ethicists, social workers, and palliative care specialists, can provide comprehensive support in such situations. By investing in education and creating an environment that promotes open dialogue, nursing staff can enhance their ability to navigate challenging ethical issues effectively.