Need help finding Nursing Ethical Dilemma articles

[carmitbb]

Hi, I am doing a nursing ethical dilemma essay recently and I couldn't find any good articles about it. Does anyone have any good nursing ethical dilemma articles to share. Thank you

[Esme12, ASN, BSN, RN]

is it good ethical dilemmas to write? please give me some ideas about the 2 articles here.

http://news.nurse.com/article/20090525/NATIONAL01/90520001

http://news.nurse.com/apps/pbcs.dll/article?AID=2005503140357

To write a paper in nursing school is to get you to think about your feelings. How do you feel? What would you do? How does that make you feel? What do you feel about assisted suicide? Can you assist with an abortion? Can you care for a prisoner in your hospital on your floor that is a child molester? YOur best friend works with you and you discover she is diverting meds for cash.....What would you do? You know a surgeon is intoxicated when he came to see the patient....What would you do? Would you tell someone?

Look into your heart.....as a nurse you will face many challenges that conflict with your personal beliefs.....the reason for the assignment is for you to ask yourself....What will you do? How do YOU feel!

Pick your dilemma......tell us how you feel. Then we can give you opinions on why we would feel differently.

Good luck.....

[systoly]

is it good ethical dilemmas to write? please give me some ideas about the 2 articles here.

http://news.nurse.com/article/20090525/NATIONAL01/90520001

http://news.nurse.com/apps/pbcs.dll/article?AID=2005503140357

I'm sorry, but I actually don't feel these are good scenario's. I believe the legal issues override everything else and these are not common situations. Why not browse the threads on this forum and look for headings such as ...what to do... what would you do...etc. I guess I'm partial to the ethical dilemmas that crop up day in day out. You might look under the student section as well, because clinicals are where the worlds collide.

[systoly]

How do you look for articles? Do you use the shotgun approach and pick something that fits the topic or do you have a situation in mind and are looking for an article that matches? Do you use mainstream search engines or do you look at medical sites?

[classicdame, MSN, EdD]

Check out American Journal of Nursing and ANA's journal. Both have column's dedicated to nursing ethics. Check for anything written by Leah Curtin. This is her speciality and she writes so professionally.

[carmitbb]

I found another ethical article. Do you think this one is better. What ethical principle apply here (justice, trust, beneficence?) and how the nurse solved the ethical dilemma. Thanks

The Case of Ms. Haddad

Ms. Haddad was a 36-year-old Muslim woman who was being admitted for extensive gastrointestinal testing. The patient was accompanied by her sister, who explained to the admitting nurse that her sister spoke primarily Arabic and had only limited English skills. She said she would remain with Ms. Haddad and interpret as needed. Who Should Be the Interpreter? Amy, the admitting nurse, excused herself and went to confer with her manager. Amy told her manager she was concerned about the ethics of confidentiality if the sister acted as an interpreter. The manager suggested that Amy ask Achmed, the unit’s social worker who was certified as an Arabic interpreter, to assist. However, accompanying Amy back to Ms. Haddad’s room, Achmed explained that most Arabic women are uncomfortable with having nonrelated males in their room and prefer

female family members to serve as interpreters. Achmed’s prediction proved to be correct. When

Achmed explained to Ms. Haddad

and her sister that he was

the Arabic interpreter, the patient

indicated she would prefer

her sister interpret for her.

Achmed documented that he

had offered interpreter services

(as required by the Office

of Civil Right’s [2000] interpretation

of the 1965 Civil

Rights Act for persons with

limited English proficiency

skills) but that Ms. Haddad requested

her sister serve as

her interpreter.

Amy conducted the admission

interview, with Ms. Haddad

‘s sister serving as the interpreter.

Amy found the

sister very helpful. She answered

questions when the

patient did not understand

and always translated for her

sister when necessary. As her

rapport with the patient and

her sister increased, Amy felt

comfortable asking more about the Muslim culture

that would be important for healthcare

providers to know.

Questions About Diet

Amy asked about preferred diet and discovered

that Ms. Haddad followed a Muslim halaal diet.

The institution did not prepare halaal diets; however,

they did have arrangements with an outside

provider for kosher meals, which are prepared in

the same way as halaal foods. This was acceptable

to the patient, and Amy completed the necessary

request forms.

Respecting Clothing and Culture Issues

After completing the admission interview, Amy

356 Home Healthcare Nurse http://www.homehealthcarenurseonline.com

Mrs. Haddad is a Muslim; please observe the following at

all times:

■ Assign female caregivers (nurses or aides) to this patient.

Assign female housekeepers, meal servers, and transporters

when possible. (If not possible, make sure that another

woman is in the room with a male provider.)

■ Respect her modesty and privacy.

Conservative Muslim women dress to show no more than their

faces and hands to anyone other than very close relatives.

Provide long-sleeved gowns or a robe with long sleeves.

Allow her to wear her own hair covering (hijab/headscarf).

Always knock before entering room.

■ When possible, do examinations over a gown. Ask permission

before examining any covered body part, and allow her

to pull clothing aside as necessary.

■ Always make sure another woman (family or staff) is in the

room when examining the patient. This is especially important

if the examiner is a man.

■ Take time to explain all procedures and treatments. Use

family members as interpreters or contact Social Services

for an Arabic interpreter.

■ Ensure that the diet is kosher. (Contact Meal Services with

any questions.)

■ Ask patient or family member when in question about care.

■ Allow family to be with patient for support.

Figure 1. Amy’s instruction for the

care of a female Muslim patient.

gave the patient a hospital gown and asked the patient

to put on the gown and get into bed. When

Amy returned to the patient’s room, she found

both the patient and her sister holding the hospital

gown and looking very apprehensive. When

she asked if something was wrong, the patient’s

sister explained how important modesty was for

Muslim women and that bare arms were unacceptable

to her sister.

Being unable to locate a long-sleeved patient

gown in the institution, the nurse helped her patient

into a lightweight robe that had long sleeves

and was more concealing than the gown. This

made both women smile. Amy, aware of the import

of modesty, completed her physical assessment

without exposing the patient in any way that

would embarrass her.

Leading Staff to Be Culturally Sensitive

After completing the admission process, Amy conferred

once again with her manager, and with her

permission she posted a note on Ms. Haddad’s

chart outlining some of the most important aspects

of providing culturally sensitive care to

their new patient (see Figure 1).

Amy also sent a copy of her note to other departments

that would be involved with Ms. Haddad

‘s care. There were many comments about Amy’s

note. Several people questioned why one patient

was receiving “special” attention, and several people

questioned the idea of female-only caregivers:

“Was this patient biased against male nurses?”

Amy tried to explain the Muslim concept of

modesty was not a bias but a cultural norm for

this patient. She further argued that being culturally

sensitive was an ethical responsibility and a

nursing responsibility. When the objections persisted,

she took the problem to the Institutional

Ethics Committee.

Ethics Committee Deliberations

The Institutional Ethics Committee met to consider

the ethics of the question about changing

certain institutional practices in deference to individuals

of differing cultures. The committee addressed

several ethical principles related to this

dilemma: justice, beneficence, non-maleficence,

and trust. Some questioned the justice of purchasing

a supply of long-sleeved gowns for a small

group of patients, the extra cost involved with obtaining

special meals, and the necessity to rearrange

assignments to accommodate the need

for female caregivers.

The response to this was that justice does not

mean that all should receive the exact same benefits;

rather, justice could be understood as the distribution

of benefits without which the care recipient

could be harmed (e.g., the additional stress

would pose a concern about maleficence). Another

member argued that anything with the potential

to improve the welfare of patients should

be our legitimate goal.

Another member suggested that not only

would meeting the cultural needs of patients be an

act of beneficence for individual patients but

could also be seen as beneficence for the Muslim

community. Some committee members also felt

that by providing culturally sensitive care, they

would be respecting the autonomy of individual

patients (e.g., supporting their personal decisions

about cultural aspects of their care as well as

building trust, which would help all reach the desired

outcomes).

The Committee’s Decision

The Ethics Committee overwhelmingly supported

the ethical arguments for culturally sensitive care.

They also made recommendations that were forwarded

to all levels of Administration.

• To form an action committee that would develop

an institution-wide program of cultural

sensitivity education that would include a review

of the National Standards for Culturally

and Linguistically Appropriate Services (CLAS

Standards) released in 2000 by the United

States Department of Health and Human Services

(DHHS) Office of Minority Health (OMH,

2004).

• That each department examine its standards

of practice for specific changes that could be

revised to encompass the needs of a culturally

diverse patient population.

Conclusion

Although many professional education programs

have traditionally included some classes in cultural

diversity, the healthcare industry and

healthcare institutions or agencies were somewhat

slow to recognize the need for culturally sensitive

healthcare environments. In 1985, the

United States Department of Health and Human

Services developed the Office of Minority Health

to study the problem of healthcare for minorities

and ethics groups and to develop programs that

promoted cultural sensitivity in healthcare.

[Esme12, ASN, BSN, RN]

A surgical liaison nurse at Boston Children’s Hospital recently found herself caught between doing what was best for her patient and his family and the rigid rules of the operating room suite. She followed the hospital’s rules, but then, together with the patient’s family, helped turn the old policy around by explaining why the rule needed to change.

The ethical quandary the liaison nurse faced arose when the mother of a baby who was dying asked to be with him in the operating room. The baby had unsuccesfully undergone heart surgery and could not be removed from the heart-lung machine. The mother wanted to go into the OR and be with her child when he died.

“The nurse told the mother she could not go into the OR, as anyone would have,” says Christine Mitchell, RN, MS, FAAN, director of ethics at Boston Children’s Hospital and associate director of clinical ethics at Harvard Medical School in Cambridge, Mass.

The parents were allowed to see their baby after he died and his chest had been stitched back up.

The next day the parents returned to the hospital and paged the liaison nurse. They told her they wanted to see the baby again before returning home, Mitchell says. The nurse told the family to meet her in the chapel. She åthen went to the morgue, warmed the baby’s body, wrapped him in a fresh blanket, put a cap on his head, and carried him to the chapel. The parents held their baby’s body for about an hour, talking about him and what had happened the previous day. Eventually they said their final goodbyes and went home.

A few weeks later, they wrote the nurse, thanking her for what she had done for them but restating their sorrow about not being with the baby when he died.

Still disturbed by the experience, the nurse went to see Mitchell, asking if there was anything that could be done. Mitchell says she suggested they discuss the experience with the OR governance committee and the ethics advisory committee. She also asked the nurse to call the baby’s parents and invite them to the discussion. The parents accepted the invitation and told the nurses and physicians why she needed to be with her baby when he died.

“We now have a policy that allows parents to be with their children in the OR [in those rare instances when a child dies in the OR and the parents want to be there],” Mitchell says.

Mitchell told this story during her presentation of the “Evolution of Moral Responsibility in Clinical Practice” during the Massachusetts Association of Registered Nurses’ annual spring conference, which focused on ethics in nursing practice. Nurses, she told the audience, are often caught in the middle between their many responsiblities to patients, physicians, hospitals, and their units.

In the majority of cases, what patients, their families, and physicians want is the same and does not conflict, she says. If nurses suspect an ethical issue is developing, they should talk about what they are experiencing during clinical rounds and with team members to determine what other people think about the situation at hand.

NICU Nurses Struggle with Mother’s Indifference Toward Baby

When attempts to stop premature delivery failed, the mother asked the medical team not to take extraordinary measures to save the baby, Young says. The preemie lived, but the mother showed little interest in his welfare. The nurses did everything they could think of to spark the woman’s maternal instincts, but nothing worked.

A Voice for a Dying Patient and his Wife

The nurses of a surgical trauma intensive care unit recently served as the voice for a dying man and his wife so they could be together during the last few minutes of the husband’s life.

http://news.nurse.com/article/20090525/NATIONAL01/90520001

or

Consult this work " Ethical Dilemmas and Nursing Practice (4th Edition) by Anne J. Davis and others which should give specific examples and how to resolve them.

Jehovah's witness child and the parents refuse blood.....the child will die do you take custody of the child?

What medical professionals need to realize is that Jehovah’s Witness blood policy is both complex and ever-changing. What is allowed or forbidden is difficult for everyone, including followers, to understand

http://www.freeminds.org/index.php?option=com_content&view=article&id=481:jehovahs-witness-accept-blood-a-little-known-fact&catid=19:medicine&Itemid=706

http://www.sonoma.edu/users/c/catlin/Jehovah's%20Witnesses%20Children%20who%20Need%20Blood%20to%20Survive.pd

http://www.sonoma.edu/users/c/catlin/Commentary%20on%20Johnny's%20Story.pd

http://findarticles.com/p/articles/mi_m1RYY/is_1_39/ai_n29475575/

. A case study demonstrates an ethical dilemma faced by healthcare providers who care for and treat Jehovah's Witnesses who are placed in a critical situation due to medical life-threatening situations. A 20-year-old, pregnant, Black Hispanic female presented to the Emergency Department (ED) in critical condition following a single-vehicle car accident. She exhibited signs and symptoms of internal bleeding and was advised to have a blood transfusion and emergency surgery in an attempt to save her and the fetus