Protecting Your Scope of Practice
February 21, 2021
​Assignment for Transport of Dangerous Goods Module
February 21, 2021

Discussion response

Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”

References:

  • Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.
  • Words Limits
    • Response posts: Minimum 100 words excluding references.

Discussion 1

When dealing with patients who have different values and cultures, there are many things to consider. Communication is a top priority (Burkhardt & Nathaniel 2014). In order to understand another person, you must be willing to ask questions and be open to learning. You must not place your own values on another. You also need to find ways to incorporate that culture and those beliefs into your nursing care for the patient. Some simple examples are diet requests. The patient can be given a kosher diet, vegetarian or other changes that fit what they need.
When you hold a differing value from your patient, you need to put yourself to the side. You need to focus on the patient. I had an elderly woman who was in great shape for her age. However, she was diagnosed with terminal cancer and was going to die soon. She had many loving family members. She might have survived a while longer with interventions, but she chose to go to hospice. I was saddened to think of her giving up. But, “giving up”, I have no right to think that or make the decision. She knows herself, her values and her choices.
I’ve had my share of cultural incongruence, where I didn’t understand a culture at all (Ong-Flaherty, C. 2016). I had a patient who was diagnosed with cancer. The patient was unaware of the diagnosis because their family insisted on staff not telling the patient. It was quite the moral dilemma for me. I would want to know, and I was appalled that the patient wasn’t being told. But in their culture, the patient was cared for and not given the stress of that knowledge. That is what they believed to be best.
I have an example of patient empowerment and decision making. The patient had a bowel obstruction. I know the best treatment to be bowel rest and an NG tube. I explained the treatment to the patient. The patient always has the right to refuse treatment. This particular patient wanted to eat and drink. The NG was already placed. The patient also wanted Dilaudid, which is contraindicated. I could not bring the patient food or drink, and I had no order to give the patient Dilaudid. I tried listening to the patient. I tried educating the patient. When all of those options failed, I tried getting the doctor to speak to the patient. After all of our efforts, the patient pulled out the NG and walked out the door.
There are some limits to patient empowerment. When patient safety is involved, patients lose the rights to make some decisions. In particular, patients with dementia come to mind. Many times I have seen patients dressed and trying to go home at 3 in the morning. They may not know where they are. They have no way to get home and they still desperately need medical treatment. I can’t in all good conscience let them walk out the door.

References:

Burkhardt, M.A. & Nataniel, A.K. (2014). Ethics and Issues in Contemporary Nursing (4th ed.). Stamford, CT: Cengage Learning. pg.479.
Ong-Flaherty, C. (2016). Cultural Incongruence in Nursing Education. The American Journal of Nursing, vol. 116 (11), 11.

Discussion 2

The purpose of this discussion is to discuss patient empowerment. Often a nurse and a patient do have different beliefs and values. Being a professional health care worker, we have been taught different ways to deal with these situations and how to handle the ethical dilemmas that may arise. I will give an example of an ethical dilemma and how I responded to what I thought was an unwise decision. I will also give my opinion on patient empowerment.

The factors to consider when a nurse and patient hold different values are things such as the patient’s religion and cultural beliefs. The patient’s own vision of the outcome and where they are in the process of their illness or treatment are also things to consider.

One example I have had working in the operating room where a patient had refused a blood transfusion was an ethical dilemma for me. The patient was Jehovah’s Witness, had their clergy with them the morning of surgery to help fill out paperwork correctly, and signed a blood refusal consent. Before the surgery I have a positive outlook to not have to give blood but with the high risk of blood loss I am always prepared. I had no reservations witnessing that consent in the preoperative department, thinking it was unlikely that blood was needed anyway. An adult is making an informed decision to refuse blood even after risks are discussed (Burkhardt & Nathaniel, 2014). High blood loss, long surgery, and patient’s co morbidities would have been recommendations for a blood transfusion. The surgeon had to talk to family after the surgery and let them know how closely the patient was to be monitored, including a possible extra day of stay due to the outcomes. I did feel that it was unwise to not get blood if needed but my duty as a nurse is to keep my own beliefs out of the situation.

An empowerment program called a care track, with includes occupational therapy, a geriatrician, and an RN is one way to build patient satisfaction and goal building. This is a program built to include the patient and create greater autonomy for the patient (Lofgren, et. al., 2015). The care track takes into consideration the patient’s ADL’s prior to the surgery, the plan for the length of stay in the hospital including rehabilitation, and where the patient is expected to go after rehab. The nurses are taught to be more observant to patient needs and be a coach for the patient. (Lofgren, et.al., 2015). There was a case study that has shown the length of stay for those involved with these interventions was four days shorter than those who did not have these interventions (Lofgren, et. al., 2015)

I do not think there should be limits on patient empowerment only due to the fact that we want our patients involved with their own health care. The goal is to make the patient more autonomous and give them greater responsibility. If the patient is working towards their own goals set by themselves, they are more likely to succeed, as shown in the case study.

In conclusion, we are to help patients and family find the right care based on their beliefs. Even if that means a longer hospital stay, more lab work, and different unconventional interventions for that patient. We are not sales people; we are simply informative healthcare workers wanting the best outcome for our patient. We give patients the resources needed to make the best decision.

References

Burkhardt, M. A., Nathaniel, A.K. Ethics and issues in contemporary nursing, 4th ed., (2014).

Cengage Learning: Stamford, CT.

Lofgren, PT, PhD, S., Hedstrom, MD, PhD, M., Ekstrom, MD, PhD, W., Lindberg, PhD, L.,

Flodin, MD, L., & Ryd, MD, PhD, L. (2015, September 1). Power to the patient: care

tracks and empowerment a recipe for improving rehabilitation for hip fracture patients.

Scandinavian Journal of Caring Sciences, 25, 462-469. doi:10.1111/scs.12157

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