S. Z: Ethical Dilemmas In Nursing
Ethical Practice in Nursing S.Z, a 65 year old Hispanic male, is being discharged from hospital after being admitted with a blood sugar of 589. He has been seeing a curandero to manage his diabetes mellitus type II, hyperlipidemia, and osteoarthritis. He has not taken his prescription medications for these chronic conditions, but instead takes traditional medicines the curandero tells him to take. His daughter approaches the nurse with her concerns over her father’s heath and asks the nurse if her father’s discharge orders can be cancelled; the daughter would prefer the doctor write orders for her father to be admitted to a nursing home. An ethical dilemma is defined as a conflict that arises when “the right thing to do is not clear
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or when members of the health care team cannot agree on the right thing to do” (Potter, Perry, Stockert, & Hall, 2015, p.78). Within this scenario there are many ethical dilemmas that affect the nurse. Three specific ethical dilemmas in this situation are: 1) the daughter wanting her father to go to a nursing home and no longer visit with the curandero; 2) the patient not taking his prescription medications and following the treatment plan of the curandero; and 3) the patient being discharged knowing he will continue to seek treatment from the curandero and his diabetes will continue to remain out of control. Possible solutions to the ethical dilemmas stated above are keeping S.Z in hospital; if the daughter is the power of attorney and the patient in not in the right state of mind, she can determine that S.Z should go to a nursing home; and discharging S.Z with a plan to follow-up with his primary care doctor on a preferred treatment plan that encompasses traditional health treatments with Western medicine practices. Discharging S.Z with a plan to follow-up with his primary care doctor to review a treatment plan is the best course of action because it allows the patient to maintain autonomy of the situation; S.Z will be fully informed about different treatment options for managing his diabetes; and the nurse is advocating for her patient’s safety in regards to treatment methods.
Solutions to Ethical Dilemmas Based on the ethical dilemmas noted above, three possible solutions can be implemented to aid in the care of S.Z. The three possible solutions are 1) keeping S.Z in the hospital to educate S.Z on his chronic conditions and review the medications to treat his diabetes, 2) discharging S.Z to a nursing home under his daughter’s orders; and 3) discharging S.Z back home with the intent of following up with his primary care doctor to discuss the best treatment option that combines both traditional medicine and Western medicine. The first solution to the ethical dilemmas is not the best decision because it keeps S.Z in the hospital, as well as educates him on prescription medications to treat his diabetes – this takes away from his independence in making his own medical decisions. The second solution to the ethical dilemmas is not the best decision because it may be taking away his autonomy if S.Z can make rational decisions – if his daughter was his power of attorney, she could only make decisions for him, if he was not capable of making decisions for himself.
Supportive Evidence
Discharging S.Z with a plan to follow-up with his primary care doctor to review a treatment plan is the best course of action because it allows the patient to maintain autonomy of the situation; S.Z will be fully informed about different treatment options for managing his diabetes; and the nurse is advocating for her patient’s safety in regards to treatment methods.
Patient autonomy refers to S.Z deciding what the best option for himself is, whether that is discharging home to continue working with his curandero for management of his conditions, or discharging to a nursing home (Potter et al., 2015). While members of the health care team and his daughter may not believe the best option is for him to continue working with the curandero, they have to respect S.Z’s decision. Overall the goal of patient autonomy is to decide the best course of action for the patient, keeping the patient’s wishes in mind (Potter et al., 2015). By meeting with his primary care provider, S.Z can explain his rational for seeing a curandero and why he is not taking his prescription medication; the doctor can also asses S.Z’s mental health from his wife passing away. This steps into the second supporting point for the solution – having S.Z’s provider educate him on different treatment
methods.
Educating S.Z on his preferred treatment methods (traditional medicine) and educating him on Western medicine allows him to retain his autonomy of the situation, but also makes him an informed patient. S.Z may not be taking his prescription medications because he is unsure of what they do, how they should be taken, or if they are even benefiting his health, since he may not physically feel his blood sugar improving. Further S.Z may be health literate and not understand the mechanisms of diabetes and what uncontrolled blood sugar does to the body. When patients do not understand their medical condition, they are more likely to be non-compliant with their medications, negatively affecting their health (Koren, 2016). Proper education for patients has been shown to significantly increase compliance with medication regimen (Koren, 2016). Additionally, educated patients have increased compliance with their doctors’ orders and have fewer health complications (Patient Direct, 2016).
Lastly, as stated in the Code of Ethics for Nurses with Interpretive Statements, “the nurse promotes, advocates for, and protects the rights, health and safety of the patient” (American Nurses Association, 2014). By having S.Z follow-up with his primary care doctor to review his treatment plan and medications, the nurse is advocating for S.Z’s safety by making sure he has a plan of action set up to manage his diabetes and prevent further admissions to the hospital. Furthermore, the nurse is advocating for the patient’s rights by letting S.Z decide where he wants to be discharged to; the nurse would not be advocating for the patient if she were to let him be discharged to the nursing home, as this is not something that he wants to do.
Conclusion As a nurse, it is important to work in an ethical professional manner at all times to benefit our patients; when the nurse is working in an ethical manner, he/she is providing the best care possible for the patient, has the patient’s best interest in mind, and is doing what is right for the patient given the circumstances. In this scenario, the best solution is to have S.Z discharge from the hospital with a plan to follow-up with his primary care doctor to review his diabetes, his prescription medications, and the current treatment plan S.Z is following from the curandero. This allows S.Z to maintain his autonomy, but also allows him to express his desire to work with the curandero. Additionally, the provider can assess S.Z’s mental health situation in regards to his wife’s passing.
or when members of the health care team cannot agree on the right thing to do” (Potter, Perry, Stockert, & Hall, 2015, p.78). Within this scenario there are many ethical dilemmas that affect the nurse. Three specific ethical dilemmas in this situation are: 1) the daughter wanting her father to go to a nursing home and no longer visit with the curandero; 2) the patient not taking his prescription medications and following the treatment plan of the curandero; and 3) the patient being discharged knowing he will continue to seek treatment from the curandero and his diabetes will continue to remain out of control. Possible solutions to the ethical dilemmas stated above are keeping S.Z in hospital; if the daughter is the power of attorney and the patient in not in the right state of mind, she can determine that S.Z should go to a nursing home; and discharging S.Z with a plan to follow-up with his primary care doctor on a preferred treatment plan that encompasses traditional health treatments with Western medicine practices. Discharging S.Z with a plan to follow-up with his primary care doctor to review a treatment plan is the best course of action because it allows the patient to maintain autonomy of the situation; S.Z will be fully informed about different treatment options for managing his diabetes; and the nurse is advocating for her patient’s safety in regards to treatment methods.
Solutions to Ethical Dilemmas Based on the ethical dilemmas noted above, three possible solutions can be implemented to aid in the care of S.Z. The three possible solutions are 1) keeping S.Z in the hospital to educate S.Z on his chronic conditions and review the medications to treat his diabetes, 2) discharging S.Z to a nursing home under his daughter’s orders; and 3) discharging S.Z back home with the intent of following up with his primary care doctor to discuss the best treatment option that combines both traditional medicine and Western medicine. The first solution to the ethical dilemmas is not the best decision because it keeps S.Z in the hospital, as well as educates him on prescription medications to treat his diabetes – this takes away from his independence in making his own medical decisions. The second solution to the ethical dilemmas is not the best decision because it may be taking away his autonomy if S.Z can make rational decisions – if his daughter was his power of attorney, she could only make decisions for him, if he was not capable of making decisions for himself.
Supportive Evidence
Discharging S.Z with a plan to follow-up with his primary care doctor to review a treatment plan is the best course of action because it allows the patient to maintain autonomy of the situation; S.Z will be fully informed about different treatment options for managing his diabetes; and the nurse is advocating for her patient’s safety in regards to treatment methods.
Patient autonomy refers to S.Z deciding what the best option for himself is, whether that is discharging home to continue working with his curandero for management of his conditions, or discharging to a nursing home (Potter et al., 2015). While members of the health care team and his daughter may not believe the best option is for him to continue working with the curandero, they have to respect S.Z’s decision. Overall the goal of patient autonomy is to decide the best course of action for the patient, keeping the patient’s wishes in mind (Potter et al., 2015). By meeting with his primary care provider, S.Z can explain his rational for seeing a curandero and why he is not taking his prescription medication; the doctor can also asses S.Z’s mental health from his wife passing away. This steps into the second supporting point for the solution – having S.Z’s provider educate him on different treatment
methods.
Educating S.Z on his preferred treatment methods (traditional medicine) and educating him on Western medicine allows him to retain his autonomy of the situation, but also makes him an informed patient. S.Z may not be taking his prescription medications because he is unsure of what they do, how they should be taken, or if they are even benefiting his health, since he may not physically feel his blood sugar improving. Further S.Z may be health literate and not understand the mechanisms of diabetes and what uncontrolled blood sugar does to the body. When patients do not understand their medical condition, they are more likely to be non-compliant with their medications, negatively affecting their health (Koren, 2016). Proper education for patients has been shown to significantly increase compliance with medication regimen (Koren, 2016). Additionally, educated patients have increased compliance with their doctors’ orders and have fewer health complications (Patient Direct, 2016).
Lastly, as stated in the Code of Ethics for Nurses with Interpretive Statements, “the nurse promotes, advocates for, and protects the rights, health and safety of the patient” (American Nurses Association, 2014). By having S.Z follow-up with his primary care doctor to review his treatment plan and medications, the nurse is advocating for S.Z’s safety by making sure he has a plan of action set up to manage his diabetes and prevent further admissions to the hospital. Furthermore, the nurse is advocating for the patient’s rights by letting S.Z decide where he wants to be discharged to; the nurse would not be advocating for the patient if she were to let him be discharged to the nursing home, as this is not something that he wants to do.
Conclusion As a nurse, it is important to work in an ethical professional manner at all times to benefit our patients; when the nurse is working in an ethical manner, he/she is providing the best care possible for the patient, has the patient’s best interest in mind, and is doing what is right for the patient given the circumstances. In this scenario, the best solution is to have S.Z discharge from the hospital with a plan to follow-up with his primary care doctor to review his diabetes, his prescription medications, and the current treatment plan S.Z is following from the curandero. This allows S.Z to maintain his autonomy, but also allows him to express his desire to work with the curandero. Additionally, the provider can assess S.Z’s mental health situation in regards to his wife’s passing.