HLTH 3611 Professional Growth

The nursing profession is full of ethical dilemmas following its complex and multifaceted duties, responsibilities, and patient treatment procedures (Goethals, Gastmans, & de Casterlé, 2010; Pauly, Varcoe, Storch, & Newton, 2009). Working with different healthcare stakeholders and especially patients, nurses undergo many instances when they are required to refer to their nursing ethics in dealing with challenging situations. Indeed, Ulrich, et al., (2010) observe that every single day of a nurse is full of ethical concerns that demand nurses to not only reconcile their individual values with those guiding the profession but also those of the patients under their care. Several reasons explain why most nurses are not in a position to make an informed decision when faced with an ethical dilemma. These include lack of adequate resources, support, time, expertise, and the facts informing ethical issues in the nursing (Burston, & Tuckett, 2013).  

Even with the national code of ethics in place to guide nurses in their decision making when faced by a challenging nursing concern, most are the times that nurses will fail to make correct decisions. In this paper, I will be describing a situation in which I experienced a striking ethical dilemma using the seven steps of guiding nurses to ethical decision making while working in an interdisciplinary team in a leading hospital here in Canada during my nursing practice last long holiday. Having studied the chapter on “Ethical Analysis and Nursing” in our main course text; “Fundamentals of Nursing” by Potter, Perry, Hall, and Stockert, (2014), I will also give an opinion as to whether I would approach the same ethical nursing situation differently or if I would still approach is in the same manner.

The Canadian Nurses Association has been in the frontline in publishing codes of ethics guidelines meant to guide Canadian nurses’ professionalism (Potter, Perry, Hall, & Stockert, 2014). As primary healthcare providers, nurses are supposed to exploit their professional values in arriving at the most ethical nursing decisions for every patient’ treatment encounter they are involved in. All healthcare stakeholders including patients and their families have varying values and beliefs which explains the source of ethical dilemmas. The Canadian Nurses Association (2017) describes ethical dilemmas in nursing as “situations arising when equally compelling ethical reasons both for and against a particular course of action are recognized and a decision must be made…”  Failing to address ethical issues may lead to burnout and stress to both the patients and the nurses. Moreover, nurses may find themselves in legal trouble such as medical negligence.

During my nursing practice last long holiday in a hospital here in Canada, I built a lot of professional resilience after dealing with numerous ethical nursing issues especially those of direct patient care. One nursing situation with striking ethical dilemma concerns occurred when I was involved in an interdisciplinary team working to deliver a surgical procedure on a 49 year old woman with acute dysmenorrhea symptoms that had led to uterine fibroids (leiomyomas) diagnosis. She lived with her husband and a 13 year- old daughter. Her two other children lived in a town a couple of miles away.  She had been diagnosed with mild depression some time back.

The operating room is one room in a hospital that will never lack ingrained ethical dilemmas with both healthcare providers and their patients diffused in their own worlds on what ought to be the most optimal course of action. Those relating to surgical procedures ought to be given priority and addressed accordingly.  As we prepared for the procedure ahead by completing the operating room checklist, we graciously spoke to the patient for moral support since at that point in time; patients are usually in a panic mode. After scrubbing our patient for an emergency Total Abdominal Hysterectomy via general anaesthesia at the holding room, we wheeled her to the theater. The procedure started off shortly after observing the operating room routine by cutting the skin. After a few moments we reached the uterine lining and to our amazement, the uterus showcased normal physiology with absolutely no traces of fibroids.

Being an emergency booking and bearing the complexity of such an operation, confusion and conflicts filled the whole operating room. However, upon consultation, it was agreed that a further exploration be done before closing the womb. As opposed to the earlier diagnosis report, it was established that the cause of the dysmenorrhea symptoms was indeed due to ovarian cysts. Ovarian cysts which could result from pelvic infections has the potential of causing hydrosalpinges which is responsible for major menstrual cycle disturbances, dysuria, infertility ,dyschezia, dyspareunia, and  postcoital bleeding  (Wallace, Keightley, & Gie, 2010). To this end, this too needed to be removed there and then.

Though prior consent had been secured from the patient’s husband with regard to the removal of the uterine fibroids, the husband was hesitant to give new consent for the removal of the ovarian cysts. Larsson, Sahlsten, Segesten, & Plos, (2011) observe that this is one of the greatest barriers to comprehensive surgical procedures. However, being an emergency and already the operation being in great progress, the cyst had to be removed immediately regardless of what his opinion was. Schenker and Meisel (2011) observe that the advantages of moving right ahead with such a procedure far outweigh time-lags of waiting for an informed consent from a family member. Even with complexities that come with a Total Abdominal Hysterectomy such as surgical injuries to major organs such blood vessels, and the bladder; excessive bleeding; urinary tract infections; anesthesia and post operation blood clots, the operation was overly successful and no further complications were reported. The patient was later stabilized at the post-anaesthetic recovery room (PARU) where upon recovery to her senses was briefed on the surgical procedures done on her. Though she showcased disappointment, she later came to terms with the situation bearing the gravity of health challenges she would have undergone if the cyst wasn’t removed.

In analyzing this ethical dilemma in accordance with the seven steps as discussed in chapter 7 of the book “Canadian Fundamentals of Nursing” by Potter, Perry, Hall, and Stockert, (2014), I recognize and state that this situation constitutes a nursing ethical dilemma. There is a conflict between healthcare practitioners as to whether to proceed with the surgery after the discovery that indeed it is not the uterus that has a problem but the ovaries. Secondly, there is a dilemma as to whether to continue with the surgery with or without the new consent of the husband bearing in mind that this is a reproductive surgery that necessitates that both the husband and his wife should consent to such effect.

After recognizing and stating the problem informing the ethical dilemma, we gathered and checked the patients’ relevant information that could help us move ahead with the new surgical procedure. In doing so, we reviewed the patient’ s laboratory tests and results, family arrangement with regard to birth control, ultrasound results as well as the availability of blood just in case she needed to be added. Thirdly, we identified relevant factors that could possibly give us motivation to continue or bar us from the same. These included our professional codes of ethics, personal values as well as those of the patient and her family. At my personal level, I thought that since I am a devoted Christian and it is God’s purpose for us to preserve and protect life, then we had an obligation to do so.

This possibly could not have been the values and beliefs for the rest of the interdisciplinary team or of the patient and her family. Under her anesthesia condition she could not voice her opinion yet we needed an argent urgent decision. Pauly, Varcoe, Storch, and Newton, (2009) observe that all healthcare practitioners’ codes of ethics encases them with the responsibility of advancing safe, quality , ethical care that enhances human dignity. This was enough to permit us move ahead with the procedure despite hesitation of being granted informed consent by the husband.

Fourthly, developing a list of alternative options to evade the dilemma gave us an opportunity to deliberate as a team on the benefits and downsides of various causes of action. Fifthly, we tested the various alternative causes of action. In doing so, we considered different tests in a bid to be on the safe side in case of being adversely implicated for medical negligence (Fry, Johnstone, & Fletcher, 2008). Sixthly, upon successful testing of options and reflecting on all the other facets above, we made a decision to remove the ovarian cysts. Letting the cysts stay would have meant more healthcare challenges to the patient and her family.

Lastly, we reflected on the outcomes and whether a better option was available than the one we had engaged in. Since the patient was in an anaesthesia condition, she obviously could not give the consent we desperately needed and therefore the husband had to undergo thorough explanation of the detriments of an ovarian cyst and why it was important for it to be removed. Judkins-Cohn, Kielwasser-Withrow, Owen, & Ward, (2014) insist that patients and their families must give their consent in any type of surgical procedures after being thoroughly briefed of alternatives. As such, after the husband understood the healthcare implication of the ovarian cysts, he gave his consent and the procedure moved ahead smoothly knowing that the team had bleached no procedures.

If I were in the same ethical situation again, I think I would make the same decision again. Nothing would change. Like it has been enshrined in the nursing code of ethics [CNA, 2017] that nurses can make healthcare decisions that are in the best interest of their patients regardless of the patients’ and family’s opinion, then this was the best decision the interdisciplinary team in this scenario could have made. DeKeyser Ganz and Berkovitz, (2012) assert that the various codes of ethics of different healthcare professionals give them the opportunity to disagree to agree on their contradicting ideas at first. Indeed, comprehending the ethical dilemma at hand, allowing practitioners to reflect on the individual and professional ethical frameworks by and large advantages patients to make informed healthcare decisions (Schenker, Fernandez, Sudore, & Schillinger, 2011).

References

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Canadian Nurses Association (2017). Code of Ethics for Registered Nurses. [Retrieved, from] https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive. Accessed 13/9/2018

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