For this assignment, you will analyze an ethical dilemma using the decision-making process described by the Markulla Center for Applied Ethics.
Steps
Choose an ethical dilemma that you have faced at some point in your clinical practice or as a nurse leader in which a decision had to be made if something is \”good\” or \”bad.\” This could be a dilemma that is currently a part of your practice or a situation that occurred in the past.
1. Use this Google Sheet to ensure you are following all of the steps of the assignment Clinical Ethical Analysis Worksheet for your information, does not have to be turned in (Links to an external site.)
2. Follow the steps in the Markkula Center for Applied Ethics Making an Ethical Decision framework. Here is a link to the framework: How to Make an Ethical Decision (Links to an external site.) Include all 10 steps of the model in your analysis. This web page (Links to an external site.) contains detailed information about using the framework.
3. Write a final reflection paragraph for a conclusion addressing how you can use this decision-making framework in your future work as a DNP-prepared nurse. Include implications for future practice or leadership roles.
4. Submit your work to the dropbox.
5. The assignment length is 5 pages. Please review the Academic Writer tutorial on conciseness (Links to an external site.) before you begin your paper.
6. Follow APA 7th ed. formatting. For this assignment, this means title page, no running head, numbered pages, headings as appropriate, and a reference list.
Search Strategy
For this assignment, try combining the keyword you use to describe your ethical dilemma with ethics. For example, “informed consent†AND ethic*. Quotations are used around your keyword/phrase if it’s more than one word. Use * at the end of “ethic†to tell the database to find all the other iterations of the word (ethics, ethical, etc). Other search terms to consider would be, justice approach, rights approach, common good approach. Databases that could be considered would be Medline and CINAHL. You may also use the course readings for any references. For a refresher on using MEDLINE and MeSH subject headings check out this video: https://www.youtube.com/watch?v=A1-RiogKstU&ab_channel=FNULibrary (Links to an external site.)
Suggested Format
Paragraph 1- Introduction/Recognize and Ethical Issue. Describe an ethical issue that you have faced in your clinical practice or as a nurse leader. Describe if this issue is about what is legal or what is most efficient.
Paragraph 2- Get the Facts- What are the relevant facts? What facts are not known? Do I know enough to make a decision? What individuals and groups have an important stake in the outcome? What are the options for acting? Have all relevant persons and groups been consulted?
Paragraphs 3 & 4- Evaluate Alternative Actions- Which option best respects the rights of all who have a stake? (The Rights Approach). Which option treats people equally or proportionately? (The Justice Approach). Which option best serves the community as a whole, not just some members? (The Common Good Approach). Which option leads me to act as the sort of person I want to be? (The Virtue Approach).
Paragraph 5- Make a Decision and Test It- Considering all these approaches, which option best addresses the situation? If I told someone I respect—or told a television audience—which option I have chosen, what would they say?
Paragraph 6-Act- How can my decision be implemented with the greatest care and attention to the concerns of all stakeholders?
Paragraph 7- Reflect on the Outcome- How did my decision turn out and what have I learned from this specific situation?
Paragraph 8- Write a final reflection paragraph for a conclusion addressing how you can use this decision-making framework in your future work as a DNP-prepared nurse. Include implications for future practice or leadership roles.
Clinical Ethical Consideration
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Introduction and Ethical Issue
Nurses often encounter ethical issues associated with their nursing care and managerial duties. In such situations, nurses are often forced to make decisions between competing values. Regardless of the circumstances, nurses are expected to make decisions that promote the interest of the patients (Aitamaa et al., 2019). In clinical practice, one of the ethical issues I encountered involved a 15-year-old patient who experienced severe depression which led to isolation, difficulty concentrating in class, and poor performance. However, she came to the hospital alone and did not want her parents to know that she had mental health problems because these issues were heavily stigmatized in her culture. The ethical dilemma that arose was that she required her parents’ consent to begin treatment and also relied on her parents’ medical insurance so even if we could proceed with treatment, her parents would still know about it. Legally, the patient’s parents needed to consent to the treatment. On the other hand, the patient’s mental health was worsening. As per Tabak and Zvi (2018), the ethical responsibility of healthcare professionals is to ensure that patients receive the best care possible. For minor patients, nurses and other healthcare workers are tasked with passing on necessary information regarding diagnosis and treatment. To fulfill these responsibilities in the scenario, it was necessary to come up with a solution that would be of most benefit to the patient.
Getting the Facts
The ethical issue was rather complex. The relevant facts were that the patient was unwell and needed treatment as soon as possible to improve her quality of life. There were no unknown facts. The patient described how her parents considered people with mental health issues as crazy and that it would be almost impossible to convince them that she needed treatment. In the scenario, the patient had an important stake in the outcome. If her parents gave consent, she would access treatment and if they did not, she would not access it. The patient also stated that she feared talking to her parents about the issue. In the scenario, the first option for acting was to reach out to the parents, with the patients’ permission, and advocate for the patients’ need for treatment. The second option was to let the patient go without any treatment and the third option was to provide treatment without parental consent. When assessing the options, I consulted with the nurse leader in the unit who demonstrated an understanding of the seriousness of the situation and helped me go through the alternatives.
Evaluating Alternative Actions
Using the rights approach, the ethical action is the one that respects and protects the moral rights of the individuals involved. In the scenario, the first option respects the moral rights of the involved parties (Markkula Center for Applied Ethics, 2021). The patient has a right to access treatment hence it is necessary to select the alternative that gives her that opportunity. The parents are legal guardians hence they have the right to be informed about their daughters’ medical condition. The justice lens focuses on the fair treatment of the involved parties. Using this approach, talking to the parents would be more suitable because they will be provided with the opportunity to help make a suitable decision for their daughter and the patient will have a chance to access treatment. Using the utilitarian approach, the option that produces the best and least harm is to talk to the parents because if the parents are convinced of their daughter’ need for treatment, they will provide consent. If the patient is treated without their consent, the parents would still know because the daughter uses their health insurance and this would present legal issues. If the patient is let go without treatment, her mental health may deteriorate further.
The common good approach focuses on selecting the option that serves the entire community (Markkula Center for Applied Ethics, 2021). The scenario includes three parties: the patient, her parents, and the healthcare provider. Educating the parents about mental health and the need for treatment would eliminate the stigma they have regarding people with these disorders and this would be beneficial to the community. Additionally, communicating with the parents and involving them in the treatment process will help improve their relationship with the patient. Using the virtue approach, I would choose to communicate with the parents. As a nurse, I strive to engage in actions that are in the patient’s best interest. Talking to the parents would promote the patient’s interest because it would provide an opportunity to obtain consent and give the patient a chance to be treated.
Making a Decision
When working with minors, it is the role of the nurse to ensure that parents acknowledge the rights of their children and to act as the advocate and case managers (Tabak & Zvi, 2018). Based on the approaches described above, the option that best addresses the situation is to reach out to the parents and talk to them about mental health and the benefits of treatment for their daughter. I feel that if I told someone about the decision I made, they would applaud me for considering the patient’s interests and respecting the parents’ right to provide consent.
Act
The best way to implement the decision with the greatest care is to follow a culturally sensitive communication approach. As per Gopalkrishnan (2018), culture plays a significant role in mental health since it influences help-seeking behavior, coping strategies, stigmatization, and the ability to adhere to treatment plans. When implementing the selected action, I reached out to the patient’s parents and organized a face-to-face meeting. I ensured that the patient was present and began the meeting by asking about their beliefs regarding mental health. I focused on being genuine and not judging their perspectives. I also inquired about any traditional or religious customs that influence their perspectives about mental health issues and learned the reason behind their beliefs. I then described the biological nature of mental disorders and other facts such as the types of these disorders, severity, and treatment strategies. I included information on the importance of treatment for diagnosed patients and why their daughter needed treatment. Finally, I gave the patient the chance to express what she feels to her parents, including the symptoms she was experiencing and their impacts on her social and academic life. I used verbal communication skills and active listening to enhance their knowledge about mental health and convince them to provide consent.
Reflecting on the Outcome
The action I took was successful because the patient’s parents gave consent for the treatment. They also learned more about mental health disorders and were very concerned about their daughter’s welfare. The patient informed her parents that she wanted to begin therapy sessions as the main treatment option and they supported her decision. I also provided additional information regarding confidentiality in therapy to explain that the therapist would not disclose any information discussed with their daughter to them.
The situation enhanced my understanding of the importance of beneficence, an ethical principle that focuses on making decisions that promote the interests of the patient. I also understood that nurses are mediators in that they can intervene to solve issues between parents and their children. Moreover, I applied cultural competence skills which are always necessary when working with diverse patients and their families. I realized that these skills contributed to successful mediation between the patient and her parents.
Conclusion
The Markkula Center for Applied Ethics Making provides a comprehensive decision-making framework that considers what is good and bad rather than the law and accepted social practice. As a DNP-prepared nurse, I intend to continue applying the framework in clinical practice. I am aware that in the future, I will encounter more complex clinical scenarios that require decision-making skills. The decision-making framework also has significant implications for future leadership roles. As a future nurse leader, I intend to be a role model to other nurses and create a work environment that promotes ethical decision-making. Therefore, I will ensure that I respect human dignity and support ethical competence development for the nurses. I will also create a framework for ethical standards based on the decision-making framework to provide guidance. Moreover, I will ensure that staff nurses and managers can engage in open discussions regarding ethical issues in patient care.
References
Aitamaa, E., Suhonen, R., Puukka, P., & Leino-Kilpi, H. (2019). Ethical problems in nursing management – a cross-sectional survey about solving problems. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4245-4
Gopalkrishnan, N. (2018). Cultural Diversity and Mental Health: Considerations for Policy and Practice. Frontiers in Public Health, 6. https://doi.org/10.3389/fpubh.2018.00179
Markkula Center for Applied Ethics. (2021). A Framework for Ethical Decision Making. https://www.scu.edu/ethics/ethics-resources/a-framework-for-ethical-decision-making/.
Tabak, N., & Zvi, M. (2018). When parents refuse a sick teenager the right to give informed consent: the nurse’s role. AUSTRALIAN JOURNAL OF ADVANCED NURSING, 25(3), 106-111. Retrieved 22 April 2022, from.