Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. Assignment:

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Practicum Journal Entry: Analyzing an Ethical Decision You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

 To prepare:

• Review literature for moral/ethical issues encountered by a PMHNP.
• Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

 Write a 2-page paper in which you do the following: Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

• Summarize the moral/ethical issue in the article (no more than 1 paragraph).
• Describe the moral and ethical dilemmas surrounding the issue.
• Analyze the ethical issue and compare them to the state health laws and regulations in your state.
• Outline the process of ethical decision making you would use to address this ethical dilemma Assignment: Practicum Journal Entry: Analyzing an Ethical Decision.

Journal Entries

Summarize the moral/ethical issue in the article

Silva, Till and Adshead (2017) presents the case of Ben, a middle-aged man who has been presented with schizophrenia that is treatment resistant. Over the last 20 years, he has been subjected to different treatment plans. Based on the results of psychiatric analysis, it is determined that Ben does not have the capacity to make informed decisions given his mental state and inability to address his basic needs. In fact, the patient has been detained in a psychiatric facility for involuntary treatment. Over the time that he has been a resident in the facility, Ben exhibited violent behavior and delusionary conduct that necessitated isolation away from other patients in a secure room. The psychiatric care team has determined that the patient has reached a crisis point since his situation is deteriorating with no hope for a reversal. Given the situation, the team decides to explore an experimental schizophrenia treatment approach that is anticipated to address the patient’s needs.

Describe the moral and ethical dilemmas surrounding the issue.

The moral dilemma is whether or not the treatment team should subject the patient to the experimental treatment. The dilemma is specifically caused by the fact that the efficacy and effectiveness of the treatment have not been determined with the possibility that the patient could be harmed in the long run. Although the patient is not competent enough to make decisions, and the medical care team acts as a proxy to make care decisions, there is a concern that the experimental treatment has not been approved for public use. As such, the situation creates an ethical dilemma for the psychiatric care team whereby the could either watch by as the patient’s situation deteriorates unable to improve the patient’s condition, or try out an experimental treatment that could worsen the patient’s condition or improve it Assignment: Practicum Journal Entry: Analyzing an Ethical Decision.

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Analyze the ethical issue and compare them to the state health laws and regulations in your state.

The law indicates that medical care teams have implied consent when offering medical care in emergency situations. The law is clear that if the patient is unable to make an informed consent and no surrogate decision-maker is in place to make the decision for the patient, then the medical care team can act on behalf of the patient and make decisions. The law makes it clear that if the patient is incompetent or incapacitated and a surrogate decision maker is not available to make decisions for the patient, then the healthcare team would be the appropriate decision-maker, acting in the best interest of the patient until an appropriate surrogate decision-maker is appointed or found. The law further adds that should an appropriate surrogate not be found, then the courts would appoint a guardian ad litem to make decisions on behalf of the patient (Marquis & Huston, 2014; Stahl, 2014) Assignment: Practicum Journal Entry: Analyzing an Ethical Decision.

Outline the process of ethical decision making you would use to address this ethical dilemma.

Given the present situation, it can be assumed that the patient does not have a surrogate decision-maker or a guardian ad litem to make decisions. As such, it is left upon the medical team to make the decision. Since the patient’s situation can be considered as an emergency with the condition likely to deteriorate if an appropriate treatment plan is not implemented, then it would be prudent for the medical care team to make a decision on whether or not the patient should be subjected to the experimental treatment. The decision on whether or not the patient should be subjected to the experimental treatment should be based on medically justified arguments with clear analysis showing whether the risk is actually worth taking. Overall, the decision on whether or not to subject the patient to the experimental treatment should be based on the possible benefits exceeding the likely harm Assignment: Practicum Journal Entry: Analyzing an Ethical Decision.

References

Marquis, B. & Huston, C. (2014). Leadership roles and management functions in nursing: theory and application (8^th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Silva, E., Till, A. & Adshead, G. (2017). Ethical dilemmas in psychiatry: when teams disagree. BJPsych Advances, 23(4), 231-239. doi: 10.1192/apt.bp.116.016147

Stahl, S. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications (4^th ed.). New York, NY: Cambridge University Press Assignment: Practicum Journal Entry: Analyzing an Ethical Decision