Beth, an 86 year old patient residing in a nursing home shows all signs of alert and with no indication of dementia. Due to her old age and the associated frailties, Beth has had unsteady movement and has a positive history of falls. Despite the many efforts to manage Beth and prevent the occurrence of such falls, the nurses have had a hard time dealing with Beth due to aggression and resistance to utilize the available measures that the care team considers pertinent to her safety. Beth is cognitive and coordination are considered as exposure factors that could lead her to falls and injuries and the nurses have devised several strategies to manage these risks and exposures among them is the to limit her movements within the nursing home to avoid falls which can cause her to break her hip and probably subject her to total immobility. The nurses have explained in detail to Beth why such limits are being placed on her. On the other hand, the nurses have organized for a walking frame to help her during movement which she can easily use but she has rejected its use.
Further, the nurses have asked Beth to wear the belt anytime she sits down to so that anytime she is standing up to walk she can call out for help to help monitor her movement. In all these measures, Beth has opposed calling out that they are meant to take away her freedom which she is not ready to let go at this time. In order to have her use the belt, the nurses have been forced to tell Beth that the facility has a new policy that requires all patients to wear the belt and it is the that she decides to have the belt every time she is sitting down. She says she is doing this because she fears that doing the contrary would be breaking the laws within the nursing home. The nurses have incorporated her family into these safety talks to help manage Beth but they have not succeeded as much save for the use of the belt which has been achieved in some desperation.
This paper will seek to delve into the discussion as to the ethical issues that arise from Beth’s case and specifically the ethical dilemmas that emanate from the issue. On one hand, the nurses are doing their best to safeguard Beth’s health and safety while on the other hand Beth considers all these measures as limitations to her rights as an individual. Within the healthcare setting, nurses encounter many issues that subject them to a point of disagreement between them and the patient or their family (Bužgová & Ivanová, 2011). Nurses are expected to allow patients and their families to have a say on the development of the care plan and the treatment regimen but that also includes the requirement that patient and family has to put on those demands that fall within the protocols within the facility (Burkhardt & Nathaniel, 2013).
In cases of disagreements, the nurses have to find a platform no which they negotiate with the patient and the family on the best approach towards managing the patient so that their rights are protected without necessarily going against the facility protocols (Ulrich,Taylor, Soeken, O’Donnell, Farrar, Danis, & Grady, 2010). Ethical dilemmas are very unique; they are typical of situations that even when a set of decisions or judgements have been made and each of them very different from the others, neither of them within the set is ‘right or wrong’ judgement or decision. In essence, each of the parties involved will find one set of decision suitable while the other may find it wrong or unsuitable for the current situation (Lillis, LeMone, LeBon & Lynn, 2010).
Discussion
There are many issues that are being manifested in this case all that indicate cases of ethical dilemmas. On one hand is the aspect of patient autonomy which in Beth’s view is being invaded for no apparent reason. For the nurses, Beth is at a point where her autonomy had to be limited to help reduce the risks to her health and safety. In Beth’s view, she does not deserve such monitoring and many other limits that impede her freedom and she thinks that even when her health is deteriorating her physicality should not in any way be an issue that is being considered to limit her freedom. On the other hand, the principle of beneficence is in some way being considered here; in the case where the nurse seeks to initiate measures that will benefit the patient with the feeling that even themselves in a similar situation as the patient would wish to have such measures implemented to safeguard their safety (Jakobsen & Sørlie, 2010).
On the case of patient autonomy, this principle demands that nurses should at all times allow patients to make decisions regarding the care process and the treatment regime adopted. Autonomy is the ability to make decisions on the ‘self’ without being controlled or coerced by any other party or being subjected to personal limitations that hinder the meaningful choice (Bužgová & Ivanová, 2011). Beth, as a patient has a right to autonomy and the care team cannot initiate any processes that may work against the will of Beth. In this case, Beth has not been ascertained as having cognitive limitations that may hinder or compromise her ability to make decisions regarding her care process save for the aggressiveness with which she has sought to protect her freedom. The nurses have to respect her autonomy and that is enshrined a part of her rights (Burkhardt & Nathaniel, 2013). However, this brings in the aspect of risk that this uncontrolled autonomy has on the safety of the patient. The nurse has to understand that the patient is in the care facility because the nurse shave been entrusted with managing her health and if that means limiting some of her freedom, then it is imperative that a negotiated format for such limitation is designed (Lillis, LeMone, LeBon & Lynn, 2010).
Patients like Beth in their old age have a perception that people around them are undermining their freedom and perceive them as weak. This usually happens especially where the patient has lived a very active and independent life and they fail to accept that old age is gradually impacting on their health and they need external help to sustain most of their day to day responsibilities that they have been performing independently in the past. In Beth’s case, the nurses have to work closely with the family so that they can collaboratively calm the fears and emotions that the patient holds in regard to the freedom and independence (Goethals, Gastmans & de Casterlé, 2010). The patient has to be assured that even before freedom, their health is the priority for the nurses and the care team and it is their duty to facilitate such independence rather than limit it. In cases where the patient’s behaviour seems disruptive to the care process, physical restraints may be proposed but in a case such as Beth who does show some cooperation, the nurses have to counsel her and gradually she will grow into a state where she can entrust the care team with the her freedom too (Lillis, LeMone, LeBon & Lynn, 2010).
On the case of beneficence, nurses have a role to balance or choose between ideal and obligatory beneficence. Ideal; beneficence is that which is based on the extreme generosity acts or even attempts to help others especially when in a state of need. Obligatory beneficence is more applicable for nurses at the professional level and it is based on promoting the wellness and welfare of the patient by eliminating harm, eliminating and minimizing risk as well as protecting the rights of the patient (Ulrich,Taylor, Soeken, O’Donnell, Farrar, Danis, & Grady, 2010). In the case of Beth for instance, the nurses are seeking to minimize and eliminate all risks that may harm Beth but on the other hand, Beth feels that the care team is gradually taking away her rights rather than protecting them in the guise of eliminating risks (Jakobsen & Sørlie, 2010). The nurses have to balance between their obligations and the needs of the patient but this is balancing is what brings in the ethical dilemma as the patient may not be ready to cede any of their demands for consensus. The integration of the family or the very trusted relatives plays a key role in the negotiations processes. It helps eliminate the generation of anger and aggression which further harm the patient and call for physical restraints which normally take away the rights of the patient forcefully and further crippling their self-determination and morale (Goethals, Gastmans & de Casterlé, 2010).
The thirds ethical issue that emanates from Beth’s case is the truth telling and cases of deception. In this case, the nurses are forced to tell Beth that the facility has a new policy on the use of belts which is not true. The nurses regard this as right in the current situation as they are desperate to protect Beth from falls and injuries based on her unsteady movement and the positive history of falls. However, from an ethical view, the nurses were acting in such a manner as failing to disclose the actual information to the patient and seeking to accomplish their obligations by any means. In a situation where the patient may be informed by someone from within that there is no such policy, the patient may lose the trust they had on the nurses and the entire care team (Burkhardt & Nathaniel, 2013).
In Beth’s case, she may even regard this as enough justification that the nurses are only seeing to limit her freedom and are not genuine on the care processes and procedures they are subjecting to her. This desperate move was seen as the last option for the nurses. However, a better option would have been to attach a social worker to Beth or in the same way develop a temporary policy in which at any time, there is a nurse in-shift who will monitor Beth’s condition after every half an hour. This close interaction while affording her freedom and less physical restraints such as the belt would gradually help her recognize that everyone in the team is seeking to assist her in recovery and assure her of less risks on her health as opposed to desperately deceiving her to achieve a temporary solution (Bužgová & Ivanová, 2011).
Conclusion
The major aspect of ethics is the ability to do ‘good’ and cause no harm as opposed to seeking the right or wrong choice. However, this ability to do ‘good’ and cause no harm is based on how each person in their individual capacity defines or describes ‘ethics’ which implies that what is ethical to one person may not be so to another (Jakobsen & Sørlie, 2010). In essence, ethics is based on the values and beliefs that each individual holds which then explains why ethical dilemmas are rife within the clinical setting. Apparently, the nurse has to base their decision on experience and negotiation with the patient and the family if at all a viable decision has to be sought out that will satisfy a majority of the demands of the ethical principles of care. The major challenge for the nurse in cases of dilemma is to balance between what is clinically and medically good to what the patient may consider good (Bužgová & Ivanová, 2011). In these instances, the nurse has to balance the patient and family preferences and the protocols which in anyway should also adhere so well to the beliefs and values that the patient and family hold. In cases where an ethical dilemma and the subsequent decision result into adverse effects on the patient, the family could decide to institute legal measures against the nurses or the facility and this could have significant impact on the ability of the nurse to continue practising or the trust of the public to the facility. In such legal battles, nurse could have their license suspended or they could lose their license in totality (Goethals, Gastmans & de Casterlé, 2010).
References
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Lillis, C., LeMone, P., LeBon, M., & Lynn, P. (2010). Study guide for fundamentals of nursing: The art and science of nursing care. Lippincott Williams & Wilkins.
Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday ethics: ethical issues and stress in nursing practice. Journal of Advanced Nursing, 66(11), 2510-2519.
