The nurse is often a moral spectator observing decisions made by others and dealing with the patient’s response to those decisions. Analyze an article about a situation where a decision by a physician, the insurance company, government agency or health institution adversely affected a patient or countermanded a patient’s wishes.

The paper should be no more than three pages not including the title page or reference page.
Provide a bibliography of at least three references, the first of which is the citation for the article you selected and the second is the Code of Ethics for Nurses with Interpretive Statements.
Using APA formatting and APA style writing address the following:
The nurse’s role in affirming the patient’s wishes and risks involved
The social and economic consequences of reversing this decision
Guidance from the Code that sheds light on this situation
The lessons to be learned for similar future situations
The moral residue that haunts the nurse

Article Analysis

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Article Analysis

Nurses are mandated to provide comprehensive and compassionate health care to patients even during the end of life cases. The mandate involves making effective decisions that integrate physiological realities, medical aspects, potential risks, benefits or alternative treatment plans, and most importantly, patient’s preferences and wishes (Burkle, 2012). The element of patient preferences has been a source of conflict among patients and physicians in achieving effective care, maintaining nurse’s Codes of Ethics, and adhering to their professional mandate. In a survey conducted by Burkle et al. when doctors were asked if they would honor a patient’s AD in a situation whereby a 62-year-old patient suffered a severe stroke or respiratory distress and had previously signed an AD on DNR/DNI, 69% of them indicated not adhering to it. When asked on the fears of legal liability the majority recorded being an essential aspect of decision-making, followed by neutral thoughts, and finally, the minority of doctors felt legal obligation was unimportant in this case (Burkle, 2012). This analysis establishes an ethical and moral nursing dilemma that requires effective decision-making.

In reference to the Codes of Ethics, nurses are mandated to promote, protect, and advocate for rights and health of a patient by integrating patient’s autonomy and affirming their preferences (ANA, 2015). However, possible risks are associated with confirming a patient’s preferences, such as in the previous scenario, including facing legal liabilities and implications. Primarily, honoring the DNR would preserve the patient’s autonomy, choices, and requires due diligence. However, if family members and designated surrogates had conflicting interests, they can sue the hospital for negligence and malpractices. Moreover, the situation places a doctor at a moral dilemma, whether to not resuscitate or adhere to their moral mandate of preserving and protecting life even at the end of a patient’s life. Thirdly, a doctor’s reputation in the clinical field may be doubted, with people claiming that the doctor followed personal interest instead of remaining objective and operating as per the nursing codes of ethics and mandates. Overly, according to the code of ethics, nurses are advised to maintain a commitment to the patient’s preferences in case conflicts of interests persist (ANA, 2015). It is essential for nurses to effectively communicate with patients on treatment plans to eliminate possibilities of ethical and moral dilemmas in nursing practice.

In cases when doctors reverse the patient’s decision and refuse to honor a DNR, they present social and economic consequences, including the presence of increased cost of care, the susceptibility of family and patient adverse confrontation, and legal concerns. Primarily, reversing the decision and patient’s preferences result in family and patient conflicts, as the AD was not honored. The major conflict would not result from saving the patient’s life, but the increased costs of care presented. In turn, economic or financial conflicts arise due to increased costs of care. Increasing care and medical support for the patient would result in increased and expensive costs, which if the patient was not prepared for becomes a significant problem (Burkle, 2012). Social determinants such as social status and poverty may adversely affect health outcomes, as it may affect a patient’s savings, financial stability, and provide issues with the hospital on payment. All these consequences result in legal complications and liabilities for both the patient, health practitioners, and the hospital.

The Codes of Ethics for nurses provides an effective mitigation strategy to understand this situation. In Provision 2, the code illustrates that persistent conflict among involved groups would recommend nurses remaining committed to the patient’s wishes. Moreover, conflict of interest among personal and professional values may arise, which requires nurses to address these conflicts in a manner that protects and promotes a patient’s benefit. Nurses should work collaboratively with medical practitioners, patient, and family members to develop an effective solution that preserves the patient’s wishes (ANA, 2015). This situation provides an arena for nurses to understand how to maneuver realities and moral dilemmas associated with nursing practice. Significant take away identified in this situation is that ethical dilemmas in nursing practice will always arise and decisions made have legal, social, and economic consequences. Secondly, these dilemmas can be solved effectively with the guidance of the nurses’ code of ethics that recommends nurses to protect, preserve, and put primacy in a patient’s interest.

Nurses are haunted by personal guilt, which is sourced from the dilemma of maintaining their mandate to protect life even at the end of life and affirming with a patient’s advanced directive. Thus, patients must be educated on the available treatment options, risks of honoring and refuting an advanced directive, and presenting alternative treatment plans to ensure moral issues as outlined above are avoided and effective care administered (Grace, 2014). Moreover, according to the codes of ethics, nurses should understand their professional boundaries even when establishing relationships and trust with patients to avoid compromising their professional mandates. This way, nurses can avoid possible conflicts of personal and professional values and consequently achieve their mandates of providing comprehensive and compassionate health care to patients without guilt or being haunted morally.

References

ANA. (2015). Code of Ethics for Nurses with interpretative statements. Silver Spring: American Nurses Association.

Burkle, C. M. (2012). Physician perspectives and compliance with patient advance directives: the role external factors play on physician decision making. BMC Medical Ethics, Vol 13(31).

Grace, P. (2014). Nursing ethics and professional responsibility in advanced practice (2nd Ed). Nursing ethics. Burlington: Jones & Bartlett Learning.