Relational Ethics In Nursing

Up holding the patient’s wishes to the best of the nurse’s abilities can seem fairly straight forward. Often, there are situations where this could be hindered by the family, who also have good intentions to protect the patient. Although the nurse may feel strongly to advocate for the patient, in these situations, it becomes difficult to ignore the request of the family who know the patient and have their best interest at heart. This creates an ethical dilemma as to how to approach the situation because there is no clear answer to what would be best for the patient.

In this scenario between Michael Grigio, the patient, and his family (See Appendix A) there are several factors that affect how to resolve the situation at hand. Relational ethics can be used as a guide to assist the family with determining a decision that will primarily respect the patient’s autonomy. Relational ethics centers on the notion that moral good and happiness of a person is rooted in our relationships with others (MacDonald, 2006). It has a strong emphasis on an authentic dialogue while respecting emotions, as well as reasons expressed by the persons involved
(Leung, 2010). Before trying to resolve the ethical issue, Amir figured out Michael’s family dynamic and why his family believes that Michael knowing his diagnosis would ruin their relationship as he would lose hope. Amir must grasp an understanding of the patient and his family’s Italian culture as well. This information can be obtained through engagement and embodiment with the patient. The key participant involved in the decision making process is Michael, the patient. As the nurse, it is important for Amir to empower Michael to make a decision that is best for him by providing him with resources and emotional support. Using the information obtained from the patient, Amir must facilitate an opportunity for the patient and his family members to talk about the issue at hand, so that they may determine a resolution on their own.

Engagement
In order to help fulfill Michael’s wishes, Amir, the nurse, must first understand his perspective. With a better understanding of Michael’s situation and vulnerability, the nurse can effectively negotiate the final decision, on disclosure of his diagnosis, between Michael and his family. Forming a genuine engagement, through active listening and authentic responsiveness, will allow the focus to be solely on Michael and what the situation means for him (Keyko, 2014). The nurse’s willingness to engage with the patient allows the patient to feel comfortable to reveal their true needs without judgement. Relational engagement is only possible, when Amir commits his full attention and become immersed in Michael’s situation. With a better understanding of Michael’s perspective and vulnerability, Amir can evaluate Michael’s developmental level and what his desires reflect. Engaging with the family to understand their culture and the reasoning behind their wishes is also very important. It would give Amir an opportunity to evaluate what is important to the family and whether a common ground could be established during the negotiation. It would also provide a better understanding of Michael’s cultural roots and their family dynamics in order to help Amir avoid any miscommunications due to cultural misunderstandings.

Embodiment Engagement will form a foundation for the development of an embodied relationship between the nurse and the patient. Embodiment suggests a relationship in which the patient is not only treated in a holistic manner but there is consideration beyond empirical knowledge that includes emotions and subjective experience (Leung, 2010). While discussing Michael’s desired outcome of finding out his diagnosis without losing his family, the nurse could explore how this could affect Michael’s emotions and his ability to cope, and the relationship with his family. Michael may have fears that he will end up alone with a scary diagnosis if he were to defy his family’s wishes. The nurse can also consider whether withholding information would truly protect Michaels’ hopes or just conceal his suffering and increase his hopelessness. Exploring the patient’s emotional distress (subjective) along with his physical signs and symptoms (objective) gives Amir the awareness required in order to understand what is ethical (Leung, 2010).

Environment
It is important for the nurse to facilitate an environment where Michael and his family feel comfortable and safe to talk to one another. The nurse must ensure that the family is open to listening to what Michael has to say, while making sure the family’s overall interests are also promoted. Amir can create a space for reflection, where everyone gets a turn to speak on behalf of how they feel. Michael will get a chance to hear why his family feels the need to hide his diagnosis. It will give him a chance to realize that his parents share his fears on how knowing his diagnosis may cause a drift between them. As the nurse, Amir should not impose any of his thoughts or force a decision, however he should empower Michael to explain to his patients why he would like to know his diagnosis, and why he believes it will be more beneficial for him. This could help the parents realize that the diagnosis will not be a burden on Michael. Amir can facilitate another open discussion where the parents can talk about what part the test result/diagnosis would go against their culture. The parents may request that Michael only ask the doctor certain questions rather than getting a full diagnosis. They may also explain how they do not want the doctor’s explanation of how much time Michael has, because it would make them feel uncomfortable (Pergert, 2012). Mutual disclosure between Michael and his family allows them to negotiate options.

Mutual Respect
By accepting each other’s different perspectives and developing a negotiation that reflects the view of all parties, we allow for the development of mutual respect. Mutual respect is the embracing of the values and ideas of others as a means to develop new understandings, rather than formulating judgements of these values and ideas. The environment created an opportunity to share an authentic dialogue and reflect on each others views. This allows for easier negotiation of solution, thus preserving the dignity of both parties while gaining respect for one another (MacDonald, 2006). An ethical decision that was created by both parties has greater will hold, greater meaning and will more likely be accepted by both parties in the long run.

Relational ethics requires that we focus on interpersonal relationships.
The nurse must focus on each of the relationships between the patient and his family and the relationship with their patient and their families. This is important for gathering information to fill in the gaps created between family members through lack of communication or strained relationship caused by the illness. In this scenario, the best way for the nurse to advocate for the patient would be to fully understand the patient’s reasoning behind wanting to know his full diagnosis and help him deliver that message to his family. Since the patient desires to please his family members, once the patient and his family are able to carry out an authentic conversation, the parents can negotiate with the patient on how much information he should know about his
diagnosis.

Reference
Erichsen, E., Danielsson, E., Friedrichsen, M. (2010). A phenomenological study of nurses’ understanding of honesty in palliative care. Nursing Ethics, 17(1); 39-50
Leung, D., Esplen M.(2010). Alleviating Existential distress of Cancer Patients: Can
Relational Ethics Guide Clinicians?. European Journal of Cancer Care, 19; 30-38
Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective.
Nursing Ethics, 21(8); 879–889

MacDonald, H. (2006). Relational ethics and advocacy in nursing: literature review.
Journal of Advanced Nursing, 57(2); 119–126

Pergert, P. (2012). Balancing truth-telling in the preservation of hope: A relational ethics approach. Nursing Ethics, 19(1); 21–29