I am SO nervous. Can you please Help?

Home Health Columnist / Guide · Jun 13, 2002

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.

Sleepyeyes · Jun 13, 2002

Hmmmm.....I can think of some things I might refuse. Do any or all of these qualify?

I'd refuse to assist at an abortion.

I did refuse once, as a CNA, to care for a LOL who I intuitively felt, wanted to sue our facility and use me to spark her fight. She asked to be put to bed, and then in the middle of undressing her, became combative and yelled that I was forcing her. I put the hearing aids back into her ears, read her her rights, and left. I was right. But thank heavens that suit never went anywhere and the LOL did--another facility. As a nurse, I would now make sure that no one entered that room without a witness :lol2:

I asked not to care for a very strong psychotic resident who became insane one night and (really!) tried to kill us because he thought we were holding him hostage. His Prozac had been DC'd abruptly and he just went psychotic. Threw things, grabbed scissors out of someone's pocket & tried to stab us with them, everything. And doc on call wasn't answering--for hours. I was the only one he'd let near him, and after that episode, I was terrified of him. (Then his meds were adjusted and eventually, he was the sweetest guy :eek: ) After a 2 week breather, I was put back with his side, but I'd bring someone in with me. (I could NEVER do psych, :nono: )

I can't think of any more but if I do, I'll be back....

jschut, BSN, RN · Jun 13, 2002

This is a hard one. Yes, I think we should have the right as nurses to refuse care to someone. But then again, if we are allowed to refuse care, where does it stop? If we don't like the color of someones hair or if they have tattoos or piercings, does that mean we don't have to care for them either?

Yes, this is a hard one...

Cascadians · Jun 13, 2002

In Oregon, the Assisted Suicide State, the patient has the right to take life-ending "medication."

We just refuse to be at the bedside when this happens, for innumerable reasons.

mattsmom81 · Jun 13, 2002

Good luck on your presentation, JEvans. There was a long (often heated) discussion last month or so along a similar vein....the thread was started by a nursing student who wanted to know if he HAD to observe a circumcision during his OB clinicals. You may want to hunt it down for additional thoughts. :) It was titled "Do I have the right to refuse to be in a circumcision" or similar title.

I have some trouble with nurses refusing care. One reason admittedly is as a charge nurse, if every nurse felt justified in refusing care to someone due to ethical/moral/religious dilemna, making assignments will become ridiculously difficult.

I have encountered many nurses who DO refuse to care for patients and although they claim dilemnas as above, I suspect they simply do not WISH to because they find the patient or care repugnant.

I was taught every patient/every person deserves basic nursing care. I may not be displaying a lot of loving concern to a murderer, or to a family whose religious/ cultural practice is to hang stinking religious artifacts about the ICU room of their family, but I CAN provide basic, decent nursing care. JMHO.

We do need to consider our own beliefs in some cases, as discussed...I would have no problem, for example, reassigning a nurse who feels morally unable to care for a patient by removing life support. I can understand those feelings and would, as a charge nurse, accomodate the nurse's request. As a staff nurse, iI have switched assignments with a nurse having difficulty with her patient for ethical reasons.

But taking care of the repugnant patient? Well, we just have to rotate and everyone takes turns...as nobody WANTS to care for that patient, but we must after all. :)

sandstormsdust · Jun 13, 2002

I can't see any nurse refusing to care for a pt on the sex/race/creed issue...

I can see a nurse refusing to administer certain meds (ie life ending,) or refusing to be in the room or present during certain procedures (ie circumcision, abortion)

But I would also think that if a nurse/ doctor objects to elements of med care, etc... they would find a position that wouldn't expose themselves to these elements

nrw350 · Jun 13, 2002

A nurse is an amazing person in that they take on this country's saying of "...bring me your down-trodden, weak, hungry, ......" because often times that is the description of some of the patients you deal with. One thing to bear in mind, is that with each new patient you care for comes the opportunity to expand your knowledge and perhaps learn something that you may not have otherwise learned of or considered.

In the past few days, I have encountered complete strangers in public (such as cashiers are wal-mart, or just someone on the street corner) that I have had quick conversations with that have prompted me to think a different way. These new thoughts are very interesting, and fun as they have been shared by me to my friends. Both the cashier at wal-mart and the gentleman on the street corner have said something to make me laugh and in turn made my day better. Honestly, I did not expect to have enjoyed the brief conversation with either one of them.

Well that is just my $0.02 on the topic. Hope everyone enjoys it lol. -- no refunds though ROFL.

Nick

Jenny P · Jun 13, 2002

Jacky, that is a very good topic for your presentation, especially if it will be the first nurse-led ethical dilemma in your facility.

Can a practitioner or nurse refuse to provide care for a patient?

I think of the nurses who have refused to care for women having abortions: I do think that we have the right to refuse giving care that goes against our core religious beliefs as long s there are others who can provide this care. Nurses caring for molesters, rapists, etc.; I think we each have to reach inside and question ourselves if we can give good care to someone who has offended society and its' laws.

Repugnant patients may or may not fall into that category also; our own prejudices do color our cares. Just because someone is filthy or has a filthy mouth or whatever, we are morally obligated to give care to people who need nursing care. Once they are all dressed alike in our "fancy" patient gowns, does it really matter if they came to us as derelects or CEO's?

But there is another area not yet addressed: that of the nurse who is (say) immunocompromised and doesn't want to care for isolation patients. Or what about the nurse who's lost a child to a drunk driver-- can she care for a patient who was drinking and driving? Or the nurse who has been injured by a violent pt. in the past-- can that nurse ever care for a confused combative pt. again?

Basically, there are different levels of dilemmas here: we have the religious and core values; the societal values; and the emotional values of the nurse which may each separately be reasons why a nurse may refuse to care for a patient. To me, the core and emotional values are good reasons for refusal of caring for a pt. (in my mind, these are not as easily controlled by the nurse); but the societal values are a large grey area. (I hope this makes sense).

betts · Jun 14, 2002

"I solemnly pledge myself to consecrate my life to the service of humanity. I will give to my teachers the respect and gratitude which is their due; I will practice my profession with conscience and dignity; the health of my patient will be my first consideration; I will respect the secrets which are confided in me; I will maintain by all means in my power the honour and noble traditions of the medical profession; my colleagues will be my brothers; I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient; I will maintain the utmost respect for human life, from the time of conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity. I make these promises solemnly, freely, and upon my honour."

Declaration of Geneva,

The World Medical Association, Sept. 1948

Sadly, this one has been largely forgotten, and today few medical graduates take any ethical pledge.

joannep · Jun 14, 2002

Grace and all other Australian nurses who post here will remember the plight of the nurses who cared for man who was responsible for the Port Arthur massacre. He received severe burns in a house fire when he was cornered by police and attempted suicide. Anyway the nurses who subsequently were responsible for his care reported many instances of verbal and written abuse by fellow health professionals as well as the general public. At the time I was horrified by the events, but more concerned for these nurses. By the grace of god I was not involved, but it could have happened in any place.

Joanne

mattsmom81 · Jun 14, 2002

Joannep, I think it must be difficult for nurses to provide care for someone who has done something horrid...like mass murderers. Imagine being the nurse for Charles Manson (eeek)or even Susan Smith (the woman who pushed her boys into a lake in a car and watched them drown) or a Hannibal Lechter type. (((shudder)))

I wonder how penitentiary nurses handle all this? They must have to remove themselves emotionally from the deeds and just focus on basic nursing care in order to function; I can only imagine. I have cared for thieves and men charged with assault but no worse, so I've been fortunate there...

jevans · Jun 14, 2002

Dear All

I am sincerely gratefull to you all. Thank you for the advice and support. I read you views and it gave me a lot of food for thought.

My own stance is that we should care for people in the same manner that we would treat our own families. There will always be dilemas of this nature but we should acknowledge our limitations and providing we act in accordance to our professional obligations we cann't go far wrong

jacky:kiss