Relevant Facts

Some of the relevant facts identified from the case study of Mary is that she has been suffering from Long-Term Cardiac Disease as well as rheumatoid arthritis which has had a tremendous impact on her mental health leading to depression since physical and mental illness and health tend to have an influence on one another (Hernandez et al., 2018). Since Mary was already suffering from cardiac disease this led to the situation of myocardial infarction or a heart attack which is caused due to lack of blood flow to the heart muscles. The lack of blood flow can occur due to several reasons however, the most common reason is associated with a blockage in one or more arteries of the heart.

Mary has been admitted to the emergency department after a myocardial infarction where she required initial resuscitation and defibrillation after which she regained consciousness. However, after regaining consciousness Mary informs the registered nurse and the student nurse that she does not want to be resuscitated again since she has long suffered from severe illnesses and that treatment options would not completely guarantee successful health outcomes. This made Mary sign a Do Not Resuscitate status where no cardiopulmonary resuscitation, respiratory support, or intubation should not be given to her but other treatments to stabilize her condition can be provided.  Ethical Principles And Decision-Making In Healthcare Example Paper

She made the decision without discussing it with her husband. However, after her further health deterioration, her husband insists to use resuscitation to revive her but is informed of Mary’s wishes. Consequently, he states that being a legal surrogate he has the right to go against the DNR status. Thus, from the facts, it can clearly be said that the situation is that of an ethical dilemma, where patients’ needs and preferences have to be respected while at the same time, prioritizing patient health is also essential.

An essential and significant role of nurses is to practice ethical practice and promote patient health and treatment outcomes by following the principles of nursing care ethics. The four principles of healthcare ethics include- autonomy, beneficence, non-maleficence, and justice (Varkey, 2021). All of these principles serve their unique objective, however when all the principles are used together then it helps in empowering healthcare professionals to ensure high-quality and ethical healthcare practices. The four ethical principles will also be applied to the case (Varkey, 2021).

Autonomy needs to be promoted by every healthcare professional while offering care, that does not allow them to persuade or force patients to follow specific treatment or take a certain medication (Buchanan et al., 2021). Ethics helps in improving the welfare of patients by giving them the opportunity to make decisions regarding their health that needs to be followed and respected by healthcare professionals and staff (Buchanan et al., 2021). However, healthcare professionals while providing autonomy need to ensure that the decision of patients does not deteriorate their health conditions.

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Ethical Principles

Thus, though autonomy has been provided to Mary, where she has decided not to be resuscitated that has helped in promoting her self-worth, however, healthcare professionals and staff should ensure that alternatives are considered that will help in stabilizing patient care and treatment (Giles et al., 2018). Beneficence is the ethical principle where nurses have to show kindness and mercy towards the patient. The principle focuses on the importance of investing time and effort to ensure the best treatment for the patient in every situation (Giles et al., 2018).

Therefore, to show kindness and mercy, nurses have to first understand the specific wants, needs, and preferences of patients and show them empathy and compassion. From the case study, it can be said that the aspect of beneficence has been considered, where the student and registered nurses have promoted patient needs and preferences and have also shown sympathy and kindness towards her by approving her decision of not resuscitating her (McDermott et al., 2018). Non-maleficence is one of the most significant and prioritized ethical principles which states that healthcare professionals should do no harm to the patients with their decisions, actions, and practices (Ilkafah et al., 2021). According to the ANA Code of Ethics, it is the responsibility of every healthcare professional to effectively evaluate every situation before making decisions (Bah & Sey 2018).

Decisions of healthcare professionals might promote patient harm therefore decisions of healthcare professionals should be clearly aligned with nursing standards and professional practice (Ilkafah et al., 2021). The ethical principle covers four factors- an act should not be completely wrong, every action should promote positive benefit, good effects should not promote the wrong action and those good decisions should outweigh bad effects (Halvorsen et al., 2021). The goal of the healthcare worker is to save patients’ life by every means possible.

Thus, it should be noted, those ethics of non-maleficence were not promoted by the healthcare professionals and the staff, where despite knowing that the decision of Mary to not resuscitate her will lead to tremendous harm to her health and negative effects, the healthcare professionals agree to her decision which has promoted patient harm (Juujärvi et al., 2019). The principle of justice promotes fairness in medical decisions.

It should be noted that patients require advanced healthcare delivery irrespective of their situation. ANA code of ethics states that the priority of healthcare professionals is to save patients’ lives irrespective of the situation (Bah & Sey 2018). However, justice is not provided in the case of Mary, where the healthcare professionals have not been successful in prioritizing patient health and safety (Juujärvi et al., 2019). Despite knowing that Mary’s decision might also lead to her death, the healthcare professionals respect her decisions instead of coming up with ways to save her life, thereby, not promoting the ethics of justice.

Decision-Making

It should be noted that improved decision-making would have helped in achieving better health outcomes. Thinking critically and analysing nursing practice would have helped in accessing the best available resources for safe quality practice and would have helped the nurses to make Mary understand how her decision might affect not only her health but also her family (Schmidt & McArthur 2018).

Adhering to the standard of functioning in accordance with law and policies that would affect nursing practice should have also been followed by the nurses that would have helped in making them understand whether approving Mary’s decision is both ethical as well as legal, and an understanding of this would have helped them to make an appropriate decision (Schmidt & McArthur 2018).

To make an efficient decision, the nurses should have also maintained capability for practice which would have ensured that they consider and respond to patient health in a timely manner that would have made them realize the importance of communicating Mary’s decision to her husband which would encourage them to perform their duties and responsibilities in an efficient manner (Chamberlain et al., 2018). The nurse should have also shown accountability and responsibility for their own actions which would have helped them to analyse what will be consequences of their decision that would encourage them to make better decisions (Chamberlain et al., 2018).

Another standard of nursing practice is to provide skilled and timely care to patients while also promoting their independence and participation in decision-making where nurses should have made the effort to make Mary understand the severity of her decision and how it will affect her and her family that would have helped in changing her decisions (Salem et al., 2018).

References

Bah, H. T., & Sey-Sawo, J. (2018). Teaching and practicing nursing code of ethics and values in the Gambia. International journal of Africa nursing sciences, 9, 68-72. https://doi.org/10.1016/j.ijans.2018.08.005

Buchanan, K., Newnham, E., Ireson, D., Davison, C., & Bayes, S. (2021). Does midwifery-led care demonstrate care ethics: A template analysis. Nursing ethics, 09697330211008638. https://doi.org/10.1177/09697330211008638

Chamberlain, D., Pollock, W., & Fulbrook, P. (2018). ACCCN workforce standards for intensive care nursing: systematic and evidence review, development, and appraisal. Australian Critical Care, 31(5), 292-302. https://doi.org/10.1016/j.aucc.2017.08.007

Giles, T., de Lacey, S., & Muir?Cochrane, E. (2018). How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?. Journal of clinical nursing, 27(5-6), e1214-e1224. https://doi.org/10.1111/jocn.14222

Halvorsen, K., Harvey, C., de Ruiter, H. P., & Jerpseth, H. (2021). Research Ethical Reflections in Researching Missed Nursing Care. In Impacts of Rationing and Missed Nursing Care: Challenges and Solutions (pp. 115-125). Springer, Cham. https://doi.org/10.1007/978-3-030-71073-6_6

Hernandez, R., Bassett, S. M., Boughton, S. W., Schuette, S. A., Shiu, E. W., & Moskowitz, J. T. (2018). Psychological well-being and physical health: Associations, mechanisms, and future directions. Emotion Review, 10(1), 18-29.  https://doi.org/10.1177/1754073917697824

Ilkafah, I., Tyas, A. P. M., & Haryanto, J. (2021). Factors related to implementation of nursing care ethical principles in Indonesia. Journal of Public Health Research, 10(2). https://doi.org/10.4081/jphr.2021.2211

Juujärvi, S., Ronkainen, K., & Silvennoinen, P. (2019). The ethics of care and justice in primary nursing of older patients. Clinical Ethics, 14(4), 187-194. https://doi.org/10.1177/1477750919876250

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473-481. https://doi.org/10.1016/j.outlook.2018.06.013 . Ethical Principles And Decision-Making In Healthcare Example Paper