I am SO nervous. Can you please Help?

  1. Hi All

    I am desperate for some help!
    My Senior Nurse approached me today with a request or shall I say "development opportunity, that I must take on!"

    I have been requested to present an ethical dilema to our Directorate. I suggested at the time that the problem I could pose is-

    Can a practioner, whether nurse or member of the multi-disciplinary team refuse to provide care for a patient?

    Two years ago I wrote about this for an assignment as a part of my degree, after a member of our team refused to care for someone who was of a different religion/ culture and found it difficult. I could apreciate how she felt and at the time took on the patient BUT felt that due to our code of conduct that professionally we have an obligation to respect patients as individuals. SO was the dilema mine or hers.

    But as an avid member of this BRILLIANT site, thought that I would ask you all first before actually committing myself

    CAN WE REFUSE TO CARE FOR A PATIENT? Even a difficult patient

    Hopeful for some feedback j

    :kiss :kiss
    Last edit by jevans on Jun 12, '02
    •  
  2. 26 Comments

  3. by   Tiiki
    [QUOTE]Originally posted by jevans
    [B]Hi All

    I have been requested to present an ethical dilema to our Directorate. I suggested at the time that the problem I could pose is-

    Can a practioner, whether nurse or member of the multi-disciplinary team can refuse to provide care for a patient?

    I think this is a great dilema to pose as I am sure it happens on a daily basis. Each nurse has their own "inner ethics" that is always at the back of your mind when taking on a new patient or when a new situation arises. I know here where I work a nurse can refuse to provide care for a patient under certain grounds, i.e. the patient is combative or if the treatment is against his/her values.

    I have been extremely lucky not to have had made that choice. Sometimes these dilema's occur after something you have done. I had a vented patient (demand mode) who's family decided to discontinue the ventillator. Oxygen would be given for comfort measures. I was there when the vent was shut off. It tortured me horribly!! I kept thinking.."I'm supposed to save lives not take them." Well, this does have a happy ending. By some small miracle the patient continued to breath on his own, and was eventually sent to an APU unit.

    Good luck with your presentation! I'm pulling for you!
    Jo-Anne
  4. by   jevans
    Thank You Jo-Anne

    Its must have been hard for you at the time. I'm sure we are put in many situations that are, in ethical terms a dilema I just need to ensure that our ethical dilema is a good example of what is happening to nurses. So far only doctors have presented

    jacky
  5. by   Tiiki
    Well I think it's about time that the voices of nurses were heard don't you? I mean who provides the majority of treatment? Who does the patient care? The MD's whip in and out in flash.

    Yes, it was awful, I recounted it for weeks. In the same situation I think I'd refuse to be present.

    Jo-Anne
  6. by   jevans
    I think I have to agree with you.
    I would have a serious issue with this type of dilema, you found yourself in.BUt I feel that as long as we provide a nurse who could cope with this situation we would have met our professional and ethical obligations

    Discussing them openly does help for future reference


    Jacky
  7. by   Gomer
    In the world of no moral absolutes I would say, yes you can refuse to care for a patient. But if you do so, you would need to face whatever consequences might occur.

    I, for one could never have given aid to Hilter. And the Bush administration would imprison me (most likely without a trial) for taking care of Mr. Bin Laden.
  8. by   CATHYW
    I have taken care of murderers, a child abuser, a filthy man who had been rolling around in his back yard trying to have oral sex with his male dog (I am NOT kidding), and various and sundry others that I would not ever have chosen as my patients. I tried to see them as, basically, a human "organism" which may be either right or wrong. I don't know. I was able to do what I had to do, politely, and well. That is part of working in the ER-everyone comes there, and SOMEBODY has to take care of the ones that everyone else didn't want. We used to rotate the oddballs, as much as possible. Most of the nurses I worked with were always pretty good about that.
    It is my personal opinion that, once we have the training, and have spoken our oath at our pinning ceremony, we are morally and ethically bound to TRY to help anyone who allows us to. To do otherwise is reprehensible. How can patients and co-workers depend on you, if you decide that you will take care of one kind of patient, but not another? What would prevent you from adding to your list of "I don't want to's?"
    On the other hand, and in a totally different scenario, I'd take GOOOOD care of Hitler and OBL. I'd want them to be healthy enough to fully appreciate the suffering of whatever sentence was handed down to them. If they need someone to start an IV for lethal purposes on these creatures, I'd be first in line!
  9. by   fedupnurse
    I have stepped in for colleagues who don't feel comfortable removing life support. I'd rather have a terminal (from whatever cause) patient die with some dignity rather than code them and all that stuff. I can totally understand why some people aren't comfortable in light of the fact that Tiiki pointed out, we are trained to save lives.
    But let me play devil's advocate here. We have some doctors who do not believe in DNR status. They are required to remove themselves from the case if they cannot abide by the patients wishes. SO they are, in essence, allowed to refuse care on their beliefs, so why not us too. One thing I remember in nursing school was the don't be judgemental crap. HELLO!! WE ARE HUMAN BEINGS, NOT MACHINES! So yes, I think it is totally ethical to not care for someone who is having something done that is against your beliefs. There was another thread about a woman who worked in a family planning clinic and was awarded money for distress of some sort related to abortions they were doing and her outspokenness about that. She had no business working in that type of facility.
    I like Cathy have taken care of people who have killed others (I consider drunk drivers on the same par with someone who gets a gun and shoots someone or stabs someone-deadly weapon!!), rapists, etc. Like Cathy, I consider them a human organism. I do what I have to do for them and am not cruel to them but they don't get any special treatment either.
    Tough question. Best of luck on your presentation, Jevans!!!!!
  10. by   hoolahan
    I think you should refuse to care for the person if you feel you will not be effective in their care. Hopefully you would be able to try it first, but if your feelings interfere with the care you give, it is not fair to the pt, and so you should ask to be removed if possible.
  11. by   Grace Oz
    Here in Aust. the patient has the right to refuse treatment from nurses, Docs etc, for whatever reason. So too, we should have the right & CHOICE to NOT nurse / treat a patient, for whatever reason. Despite all we were taught in nursing training about moral issues, legalities etc, as someone else has posted, "we are HUMANS too"!
    We should have the right to refuse to nurse ( no matter our reason!) without prejudice or prosecution!...
    The days of nurses being "handmaidens" has long since passed! Mind you, some cultures still think of nurses as lowly creatures!...
    Just adding "two bob's worth"! :-)
    Cheers
    Grace.
  12. by   Grace Oz
    PS: "Two Bobs worth" means...Twenty cents worth! :-) Have to educate you Yankees about our Aussie slang!! :-) LOL...
    Cheers again...
    Grace
  13. by   Tiiki
    Cathy put a whole new light on the question for me. The ethical dilema of caring or not caring for a patient to me, always referred to a tx as I have previously explained. I too am now an ER nurse, you never know what is coming thru those doors. We've always joked that we'll get some down and out next to a well to do snob. But ya know, in those johnny gowns, they are all equal and that's how we treat them. We get guards bringing in prisoners for tx as well. I've never seen anyone turn up their nose or refuse to handle a patient. I think this is such an amazing topic, one only nurses can relate to. (I guess it's why I keep posting!)

    Jo-Anne
  14. by   NRSKarenRN
    From ANA Code of Ethics:

    Check out 5.4 Preservation of integrity
    http://www.ana.org/ethics/code/ethicscode150.htm#9.1

    Per jevans:
    "a member of our team refused to care for someone who was of a different religion/ culture and found it difficult"

    Yes it is difficult sometimes caring for patients....My thinking is along the lines of Cathy. There have been some patients that have tried the patience of an entire nursing unit with success from interdisciplanary conference. Our obligation is if we are unable to provide care due to ethical issue is to ensure that care is provided by another staff member.

    I try to look past a persons personalcharacteristics/politics/
    venom spewing dialogue/religious beliefs to realize they are a person, creature of our creator to teach me how NOT to be.
    I also practice "Share the Wealth" with my colleagues: take on patients that are difficult to deal with so they can have a break.

close