Michael, a 35-year-old, was brought via ambulance to the emergency department after collapsing on the street. He was diagnosed with appendicitis and the surgical team was alerted to the potential surgery. The physician prepared to obtain informed consent and began discussing the simple effective surgery and the treatment with the patient. The RN was present at the bedside. The patient stated he did not want surgery. Based upon his beliefs as a Christian Scientist, it is against his practices. He requested a Christian Science practitioner. The patient rated his pain as 9 on 0-10 verbal pain scale so the RN prepared the narcotic analgesic to relieve the patient's pain. The patient declined the medication. The RN believes the patient should accept the pain medication and have the surgery thinking "If it were me I would proceed with the surgery and treatments proposed by the surgeon." The surgeon can be heard speaking to a colleague about how to go about changing the patient's decision.
State and discuss the legal and ethical considerations occurring in this scenario. Include supporting citations.
How can RNs support the patient's decision when the beliefs of the patient are contrary their own? List three (3) interventions, with supporting rationales, the RN would perform to ensure the delivery of culturally sensitive care.
Identify one (1) additional major religion, in which the same circumstances might also require the RN to advocate for the patient's refusal of surgery. Describe the beliefs behind why the identified religion could pose a moral conflict for a similar patient.
Ok, this homework question is based on misinformation regarding the belief set of the Church of Christ, Scientist.
Medical intervention is not rejected out of hand. Hopefully, the young man's practitioner will remind him that positive thought, while invaluable to the healing process, isn't going to cure his appendicitis.
Physicians and medications have their place. The feeling is that God has given physicians the talent and knowledge required to step in when needed.
[COLOR=#000000] [/COLOR][COLOR=#000000]Self-neglect and refusal of treatment inevitably pose ethical dilemmas for those involved in providing healthcare. The balance between respect for the autonomy of the patient and desire to act in a beneficent manner results in disagreement and tension. Since the 1980's, ideologies that promote patient choice, empowerment and autonomy have become widely adopted and are embedded within The Patient's Charter (Dunbar 2003).[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]The nurse will need to reflect on his/her own beliefs and values, to gain a better sense of self-awareness and understanding of any biases he/she may have. This will allow the nurse to better respect the patient's choices, beliefs and values. The nurse needs to be an advocate for the patient. (Tres. Wilkenson. 2014). The nurse may not agree with the patient's choices but he/she should support the patient and be respectful.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]How does the RN support the patient ‘s decision?[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]1. Ask the patient if he understand the diagnosis and complications that can stem from the condition if not treated.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale- If the patient has all the details and understanding then this will allow the patient to make an informed decision.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]2. Be an active listener .[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale- By doing this there is a chance to gain the patient trust and it let them know that you are concerned about his/her well-being.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]3. Consult with persons who are more knowledgeable about the patient's beliefs as a Christian Scientist.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale: So you can gain a better understanding of the patient thought process and not just be bias so the patient can get the best treatment for his condition without over stepping boundaries in his religion.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]4. Provide the patient with alternative options to help elevate pain.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale: Non pharmacological interventions also help decrease pain by promoting relaxation and redirecting attention.[/COLOR]
[COLOR=#000000] [/COLOR]Jehovah's Witness teaches that blood transfusions, even if needed to save a person's life, must not be accepted. This teaching is based upon three passages in the Bible which prohibit the consuming of blood: Genesis 9:4: "But flesh (meat) with...blood...ye shall not eat, Leviticus 17:12-14: "...No soul of you shall eat blood...whosoever eateth it shall be cut off" and Acts 15:29"That ye abstain...from blood..." This religion could pose a moral conflict for a similar patient if the religion does not allow the transfusion of whole blood or its components, their faith also does not permit donation or receipt of an organ through which blood flows (Treas, & Wilkinson, 2014, p.342).
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[COLOR=#000000] [/COLOR]
[COLOR=#000000] [/COLOR]
References
[COLOR=#000000] [/COLOR]Primary Health Care - 13(1):38 - Abstract (RCNi). (n.d.). Retrieved May 13, 2016, from http://journals.rcni.com/
[COLOR=#000000] [/COLOR][COLOR=#000000]About JWfacts. (n.d.). Retrieved May 13, 2016, from [/COLOR]http://www.jwfacts.com/[COLOR=#000000][/COLOR]
[COLOR=#000000] [/COLOR]Catalano, J. (2015). Nursing Now! Today's Issues, Tomorrow's Trends (7th ed.). Philadelphia, PA: F.A. Davis Company.[COLOR=#000000] [/COLOR]Treas, L. & Wilkinson, J. (2014). Basic nursing: Concepts, skills & reasoning. Philadelphia, PA: F. A. Davis Company.[COLOR=#000000] [/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]What do you think?
Self-neglect and refusal of treatment inevitably pose ethical dilemmas for those involved in providing healthcare. The balance between respect for the autonomy of the patient and desire to act in a beneficent manner results in disagreement and tension. Since the 1980's, ideologies that promote patient choice, empowerment and autonomy have become widely adopted and are embedded within The Patient's Charter (Dunbar 2003).[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]The nurse will need to reflect on his/her own beliefs and values, to gain a better sense of self-awareness and understanding of any biases he/she may have. This will allow the nurse to better respect the patient's choices, beliefs and values. The nurse needs to be an advocate for the patient. (Tres. Wilkenson. 2014). The nurse may not agree with the patient's choices but he/she should support the patient and be respectful.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]How does the RN support the patient ‘s decision?[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]1. Ask the patient if he understand the diagnosis and complications that can stem from the condition if not treated.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale- If the patient has all the details and understanding then this will allow the patient to make an informed decision.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]2. Be an active listener .[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale- By doing this there is a chance to gain the patient trust and it let them know that you are concerned about his/her well-being.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]3. Consult with persons who are more knowledgeable about the patient's beliefs as a Christian Scientist.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale: So you can gain a better understanding of the patient thought process and not just be bias so the patient can get the best treatment for his condition without over stepping boundaries in his religion.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]4. Provide the patient with alternative options to help elevate pain.[/COLOR]
[COLOR=#000000] [/COLOR][COLOR=#000000]Rationale: Non pharmacological interventions also help decrease pain by promoting relaxation and redirecting attention.[/COLOR]
[COLOR=#000000] [/COLOR]Jehovah's Witness teaches that blood transfusions, even if needed to save a person's life, must not be accepted. This teaching is based upon three passages in the Bible which prohibit the consuming of blood: Genesis 9:4: "But flesh (meat) with...blood...ye shall not eat, Leviticus 17:12-14: "...No soul of you shall eat blood...whosoever eateth it shall be cut off" and Acts 15:29"That ye abstain...from blood..." This religion could pose a moral conflict for a similar patient if the religion does not allow the transfusion of whole blood or its components, their faith also does not permit donation or receipt of an organ through which blood flows (Treas, & Wilkinson, 2014, p.342).
[COLOR=#000000] [/COLOR]
[COLOR=#000000] [/COLOR]
[COLOR=#000000] [/COLOR]
References
[COLOR=#000000] [/COLOR]Primary Health Care - 13(1):38 - Abstract (RCNi). (n.d.). Retrieved May 13, 2016, from http://journals.rcni.com/
[COLOR=#000000] [/COLOR][COLOR=#000000]About JWfacts. (n.d.). Retrieved May 13, 2016, from [/COLOR]http://www.jwfacts.com/[COLOR=#000000][/COLOR]
[COLOR=#000000] [/COLOR]Catalano, J. (2015). Nursing Now! Today's Issues, Tomorrow's Trends (7th ed.). Philadelphia, PA: F.A. Davis Company.[COLOR=#000000] [/COLOR]Treas, L. & Wilkinson, J. (2014). Basic nursing: Concepts, skills & reasoning. Philadelphia, PA: F. A. Davis Company.[COLOR=#000000] [/COLOR]
The first bullet in you assignment says to "state and discusslegal and ethical considerations."
You have not addressed legal considerations. What does the law say about whether someone can refuse treatment? Are there any circumstances when someone would not be allowed to refuse treatment?
In one sentence you stated there are ethical considerations, but you did not discuss them.
The assignment says to identify a major religion where the RN would need to advocate for a patient's refusal of surgery. You cite Jehovah's Witnesses. I don't believe Jehovah's Witnesses object to surgery. They just object to receiving blood products.
Pull up and read an article from an ethics journal. They are available on line.
Ok, this homework question is based on misinformation regarding the belief set of the Church of Christ, Scientist.
Medical intervention is not rejected out of hand. Hopefully, the young man's practitioner will remind him that positive thought, while invaluable to the healing process, isn't going to cure his appendicitis.
Physicians and medications have their place. The feeling is that God has given physicians the talent and knowledge required to step in when needed.
Thanks for the info! :)
I've noticed a looooot of oversimplification and misinformation when discussing cultural/religious nursing considerations. Sometime last year, there was a thread about a pt who chose to decline surgical intervention; OP was horrified. Pt happened to be Korean. Someone posted about Asian people believing in reincarnation. Um...*some* Eastern religions teach reincarnation. Christians, Muslims, atheists, agnostics -- all of which may hail from Asia, among others -- hold no such belief. Even in nursing textbooks, most of the statements about cultural beliefs are boiled down to a few sentences. It's not so simple.
To the OP -- agreed with the others that you want to focus on autonomy, informed consent, and informed refusal.
Also given that the pt HAS already declined the narcotics, consider what you as a nurse *could* suggest in the way of non-pharm interventions.
Jensmom7, BSN, RN
1,907 Posts
Ok, this homework question is based on misinformation regarding the belief set of the Church of Christ, Scientist.
Medical intervention is not rejected out of hand. Hopefully, the young man's practitioner will remind him that positive thought, while invaluable to the healing process, isn't going to cure his appendicitis.
Physicians and medications have their place. The feeling is that God has given physicians the talent and knowledge required to step in when needed.